{
  "hospital_name": "St. Louis Children's at Cox Health",
  "last_updated_on": "2026-03-01",
  "version": "3.0.0",
  "hospital_address": [
    "3801 S National Ave Ste. 130, Springfield, MO 65807-5210"
  ],
  "location_name": [
    "St. Louis Children's at Cox Health"
  ],
  "license_information": {
    "license_number": "583-0",
    "state": "MO"
  },
  "type_2_npi": [
    "1184511339"
  ],
  "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": "Harold Mueller"
  },
 "standard_charge_information": [
 {"description": "HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITH MCC", "code_information": [{"code": "001", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 10481.0, "maximum": 996017.08, "gross_charge": 1172437.79, "discounted_cash": 703462.67, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10481, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 51.1, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 59.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 60.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10481, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 59.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 59.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITHOUT MCC", "code_information": [{"code": "002", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6844.0, "maximum": 157484.25, "gross_charge": 141537.8, "discounted_cash": 84922.68, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 11276, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 9888, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9956, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6844, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 8804, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 9888, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 11276, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 8500, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 9888, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 8267, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 8267, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 11276, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 11276, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 11276, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6844, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 8804, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6844, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 8804, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 8267, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 9888, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ECMO OR TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITH MAJOR O.R. PROCEDURES", "code_information": [{"code": "003", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 10481.0, "maximum": 969527.48, "gross_charge": 1138507.11, "discounted_cash": 683104.27, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 10481, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 51.1, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 59.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 60.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 10481, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 59.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 59.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITHOUT MAJOR O.R. PROCEDURES", "code_information": [{"code": "004", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 10481.0, "maximum": 1706429.34, "gross_charge": 1822128.47, "discounted_cash": 1093277.08, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 10481, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 51.1, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 59.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 60.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 10481, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 59.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 59.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH MCC", "code_information": [{"code": "011", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 7121.0, "maximum": 161450.81, "gross_charge": 178835.67, "discounted_cash": 107301.4, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 21996, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 51.1, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 7121, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 8589, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 60.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 21996, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 8810, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 8810, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 7121, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 8589, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 7121, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 8589, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 8810, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ALLOGENEIC BONE MARROW TRANSPLANT", "code_information": [{"code": "014", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "maximum": 652278.38, "gross_charge": 767386.33, "discounted_cash": 460431.8, "minimum": 10481, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10481, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 51.1, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 59.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 60.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10481, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 59.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 59.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "AUTOLOGOUS BONE MARROW TRANSPLANT WITH CC/MCC", "code_information": [{"code": "016", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6680.0, "maximum": 224859.34, "gross_charge": 116669.91, "discounted_cash": 70001.95, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 21996, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8681, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 14292, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9761, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 21996, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES", "code_information": [{"code": "018", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "maximum": 2108290.95, "gross_charge": 2480342.29, "discounted_cash": 1488205.37, "minimum": 10481, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10481, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 51.1, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 59.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 60.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10481, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 59.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 59.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH MCC", "code_information": [{"code": "020", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 10481.0, "maximum": 357495.13, "gross_charge": 420711.45, "discounted_cash": 252426.87, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 10481, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 51.1, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 59.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 60.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 10481, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 59.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 59.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITH MCC OR ANTINEOPLASTIC IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR", "code_information": [{"code": "023", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 10481.0, "maximum": 262136.82, "gross_charge": 308396.61, "discounted_cash": 185037.97, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 10481, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 51.1, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 59.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 60.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 10481, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 59.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 59.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITHOUT MCC", "code_information": [{"code": "024", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 179072.88, "gross_charge": 103940.56, "discounted_cash": 62364.34, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 118653, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 118653, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 118653, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 118653, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 118653, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC", "code_information": [{"code": "025", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 49093.0, "maximum": 237163.43, "gross_charge": 279156.8, "discounted_cash": 167494.08, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 57884, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "other", "standard_charge_algorithm": "May include reimbursement for certain add-on services.", "standard_charge_dollar": 72075, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 72895, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 69604, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 56294, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 49093, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 62275, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 72895, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 57884, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 75755, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 72895, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "other", "standard_charge_algorithm": "May include reimbursement for certain add-on services.", "standard_charge_dollar": 72075, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 74192, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 74192, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 57884, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 57884, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 57884, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 49093, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 62275, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 49093, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 62275, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 74192, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 72895, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH CC", "code_information": [{"code": "026", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 21245.6, "maximum": 103063.03, "gross_charge": 121250.63, "discounted_cash": 72750.38, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 57884, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "other", "standard_charge_algorithm": "May include reimbursement for certain add-on services.", "standard_charge_dollar": 72075, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 72895, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 69604, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 56294, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 49093, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 62275, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 72895, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 57884, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 75755, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 72895, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "other", "standard_charge_algorithm": "May include reimbursement for certain add-on services.", "standard_charge_dollar": 72075, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 74192, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 74192, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 57884, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 57884, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 57884, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 49093, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 62275, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 49093, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 62275, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 74192, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 72895, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "027", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6485.0, "maximum": 75755.0, "gross_charge": 75675.76, "discounted_cash": 45405.46, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 57884, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "other", "standard_charge_algorithm": "May include reimbursement for certain add-on services.", "standard_charge_dollar": 63144, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 72895, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 69604, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 56294, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 49093, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 62275, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 72895, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 57884, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 75755, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 72895, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "other", "standard_charge_algorithm": "May include reimbursement for certain add-on services.", "standard_charge_dollar": 63144, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 74192, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 74192, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 57884, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 57884, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 57884, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 49093, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 62275, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 49093, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 62275, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 74192, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 72895, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SPINAL PROCEDURES WITH MCC", "code_information": [{"code": "028", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 7121.0, "maximum": 129329.3, "gross_charge": 152152.11, "discounted_cash": 91291.27, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 71408, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 21996, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_dollar": 10650, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7121, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8589, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 71408, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 60.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 21996, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 40856, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 40856, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 71408, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 71408, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 71408, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7121, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8589, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7121, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8589, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 40856, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SPINAL PROCEDURES WITH CC OR SPINAL NEUROSTIMULATORS", "code_information": [{"code": "029", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 29997.0, "maximum": 92101.38, "gross_charge": 108529.96, "discounted_cash": 65117.98, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_dollar": 71408, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "other", "standard_charge_algorithm": "May include reimbursement for certain add-on services.", "standard_charge_dollar": 90228, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 41963, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 44948, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 34950, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "case rate", "standard_charge_dollar": 43411, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 45457, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 45649, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 41963, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_dollar": 71408, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 41716, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 41963, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "other", "standard_charge_algorithm": "May include reimbursement for certain add-on services.", "standard_charge_dollar": 90228, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 40856, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 40856, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_dollar": 71408, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_dollar": 71408, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_dollar": 71408, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 45457, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 45649, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 45457, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 45649, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 40856, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 41963, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SPINAL PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "030", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "maximum": 81549.0, "gross_charge": 95512.64, "discounted_cash": 57307.58, "minimum": 34950, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_dollar": 71408, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "other", "standard_charge_algorithm": "May include reimbursement for certain add-on services.", "standard_charge_dollar": 81549, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 41963, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 44948, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 34950, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "case rate", "standard_charge_dollar": 43411, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 45457, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 45649, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 41963, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_dollar": 71408, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 41716, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 41963, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "other", "standard_charge_algorithm": "May include reimbursement for certain add-on services.", "standard_charge_dollar": 81549, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 40856, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 40856, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_dollar": 71408, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_dollar": 71408, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_dollar": 71408, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 45457, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 45649, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 45457, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 45649, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 40856, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 41963, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "VENTRICULAR SHUNT PROCEDURES WITH MCC", "code_information": [{"code": "031", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6485.0, "maximum": 70642.3, "gross_charge": 83107.93, "discounted_cash": 49864.76, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 35768, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 44028, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 48324, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 36162, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 43892, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 49097, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 44028, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 35768, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 40679, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 44028, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 39840, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 39840, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 35768, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 35768, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 35768, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 43892, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 49097, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 43892, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 49097, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 39840, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 44028, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "VENTRICULAR SHUNT PROCEDURES WITH CC", "code_information": [{"code": "032", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 9999.0, "maximum": 56327.58, "gross_charge": 66268.99, "discounted_cash": 39761.39, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 35768, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 21996, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 44028, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 48324, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 36162, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 14292, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 43892, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 49097, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 44028, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 35768, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 40679, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 44028, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 21996, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 39840, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 39840, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 35768, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 35768, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 35768, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 43892, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 49097, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 43892, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 49097, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 39840, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 44028, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "VENTRICULAR SHUNT PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "033", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6485.0, "maximum": 49097.0, "gross_charge": 56216.88, "discounted_cash": 33730.13, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 35768, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 44028, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 48324, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 36162, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 43892, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 49097, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 44028, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 35768, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 40679, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 44028, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 39840, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 39840, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 35768, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 35768, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 35768, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 43892, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 49097, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 43892, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 49097, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 39840, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 44028, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "EXTRACRANIAL PROCEDURES WITH MCC", "code_information": [{"code": "037", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 10481.0, "maximum": 493131.51, "gross_charge": 579935.51, "discounted_cash": 347961.31, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 10481, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 51.1, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 59.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 60.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 10481, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 59.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 59.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "EXTRACRANIAL PROCEDURES WITH CC", "code_information": [{"code": "038", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "maximum": 131597.16, "gross_charge": 154820.19, "discounted_cash": 92892.11, "minimum": 7121, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 53207, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 21996, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10650, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7121, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8589, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 53207, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 60.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 21996, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8810, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8810, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 53207, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 53207, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 53207, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7121, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8589, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7121, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8589, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8810, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH MCC", "code_information": [{"code": "040", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6680.0, "maximum": 169152.11, "gross_charge": 199002.47, "discounted_cash": 119401.48, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 41009, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 41009, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 60.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 41009, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 41009, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 41009, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 51.1, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH CC OR PERIPHERAL NEUROSTIMULATOR", "code_information": [{"code": "041", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 105548.78, "gross_charge": 124088.73, "discounted_cash": 74453.24, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 41009, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 41009, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 41009, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 41009, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 41009, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "042", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 59511.95, "gross_charge": 70014.05, "discounted_cash": 42008.43, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 41009, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 41009, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 41009, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 41009, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 41009, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SPINAL DISORDERS AND INJURIES WITH CC/MCC", "code_information": [{"code": "052", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "maximum": 67206.7, "gross_charge": 79059.9, "discounted_cash": 47435.94, "minimum": 7121, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 20827, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 21996, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 12391, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 10650, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 8681, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 14292, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 7121, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 8589, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 12391, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 20827, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 9761, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 12391, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 20827, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 20827, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 20827, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 7121, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 8589, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 7121, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 8589, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 8810, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 12391, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 21996, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 8810, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 8810, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "NERVOUS SYSTEM NEOPLASMS WITH MCC", "code_information": [{"code": "054", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 54624.0, "gross_charge": 32996.05, "discounted_cash": 19797.63, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 54624, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 54624, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 54624, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 54624, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 54624, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "NERVOUS SYSTEM NEOPLASMS WITHOUT MCC", "code_information": [{"code": "055", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 54624.0, "gross_charge": 23502.7, "discounted_cash": 14101.62, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 54624, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 54624, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 54624, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 54624, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 54624, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH MCC", "code_information": [{"code": "056", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 7121.0, "maximum": 41193.22, "gross_charge": 48462.6, "discounted_cash": 29077.56, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 21996, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10650, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8681, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 14292, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7121, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8589, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9761, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 21996, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8810, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8810, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7121, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8589, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7121, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8589, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8810, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC", "code_information": [{"code": "057", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 41995.8, "gross_charge": 27084.5, "discounted_cash": 16250.7, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH MCC", "code_information": [{"code": "058", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 43478.18, "gross_charge": 51290.85, "discounted_cash": 30774.51, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH CC", "code_information": [{"code": "059", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 46268.22, "gross_charge": 54433.2, "discounted_cash": 32659.92, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITHOUT CC/MCC", "code_information": [{"code": "060", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 23294.0, "gross_charge": 27404.7, "discounted_cash": 16442.82, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH MCC", "code_information": [{"code": "064", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 7121.0, "maximum": 122676.12, "gross_charge": 144671.25, "discounted_cash": 86802.75, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_dollar": 69737, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 21996, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 12391, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 10650, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 7121, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 8589, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 12391, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_dollar": 69737, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 9761, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 12391, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 21996, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 8810, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 8810, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_dollar": 69737, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_dollar": 69737, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_dollar": 69737, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 7121, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 8589, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 7121, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 8589, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 8810, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 12391, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH CC OR TPA IN 24 HOURS", "code_information": [{"code": "065", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 69737.0, "gross_charge": 58145.05, "discounted_cash": 34887.03, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 69737, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 21996, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 69737, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 21996, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 69737, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 69737, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 69737, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT CC/MCC", "code_information": [{"code": "066", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 7121.0, "maximum": 69737.0, "gross_charge": 24587.1, "discounted_cash": 14752.26, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_dollar": 69737, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 21996, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 12391, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 10650, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 8681, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 14292, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 7121, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 8589, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 12391, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_dollar": 69737, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 9761, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 12391, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 21996, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 8810, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 8810, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_dollar": 69737, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_dollar": 69737, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_dollar": 69737, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 7121, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 8589, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 7121, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 8589, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 8810, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 12391, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OTHER CEREBROVASCULAR DISORDERS WITH MCC", "code_information": [{"code": "070", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 103538.34, "gross_charge": 121887.0, "discounted_cash": 73132.2, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OTHER CEREBROVASCULAR DISORDERS WITH CC", "code_information": [{"code": "071", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 41995.8, "gross_charge": 39596.25, "discounted_cash": 23757.75, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 21996, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 21996, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OTHER CEREBROVASCULAR DISORDERS WITHOUT CC/MCC", "code_information": [{"code": "072", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 17884.04, "gross_charge": 21040.05, "discounted_cash": 12624.03, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CRANIAL AND PERIPHERAL NERVE DISORDERS WITH MCC", "code_information": [{"code": "073", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6370.0, "maximum": 46795.31, "gross_charge": 55048.8, "discounted_cash": 33029.28, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 11276, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 9888, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9956, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6370, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 7660, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6844, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 8804, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 9888, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 11276, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 8500, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 9888, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 8267, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 8267, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 11276, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 11276, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 11276, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6844, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 8804, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6844, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 8804, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 8267, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 9888, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC", "code_information": [{"code": "074", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 61324.34, "gross_charge": 71381.98, "discounted_cash": 42829.19, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "VIRAL MENINGITIS WITH CC/MCC", "code_information": [{"code": "075", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 1558.0, "maximum": 41995.8, "gross_charge": 41577.7, "discounted_cash": 24946.62, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 2468, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 2840, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 2345, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 2281, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 1558, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 1859, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 2080, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 2134, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 2345, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 2468, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 1800, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 2345, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 2840, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 1730, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 1730, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 2468, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 2468, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 2468, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 2080, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 2134, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 2080, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 2134, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 1730, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 2345, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "VIRAL MENINGITIS WITHOUT CC/MCC", "code_information": [{"code": "076", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 17793.74, "gross_charge": 20933.8, "discounted_cash": 12560.28, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "NONTRAUMATIC STUPOR AND COMA WITHOUT MCC", "code_information": [{"code": "081", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "maximum": 10498.95, "gross_charge": 7268.8, "discounted_cash": 4361.28, "minimum": 6027, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TRAUMATIC STUPOR AND COMA >1 HOUR WITH MCC", "code_information": [{"code": "082", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 7121.0, "maximum": 49430.24, "gross_charge": 57110.12, "discounted_cash": 34266.07, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 21996, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 10650, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 8681, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 14292, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 7121, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 8589, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 9761, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 21996, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 8810, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 8810, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 7121, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 8589, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 7121, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 8589, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 8810, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TRAUMATIC STUPOR AND COMA >1 HOUR WITH CC", "code_information": [{"code": "083", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 21197.88, "gross_charge": 21568.75, "discounted_cash": 12941.25, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TRAUMATIC STUPOR AND COMA >1 HOUR WITHOUT CC/MCC", "code_information": [{"code": "084", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 16349.75, "gross_charge": 19235.0, "discounted_cash": 11541.0, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TRAUMATIC STUPOR AND COMA <1 HOUR WITH MCC", "code_information": [{"code": "085", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 7121.0, "maximum": 67369.9, "gross_charge": 70989.9, "discounted_cash": 42593.94, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 21996, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 10650, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 8681, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 14292, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 7121, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 8589, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 9761, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 21996, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 8810, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 8810, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 7121, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 8589, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 7121, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 8589, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 8810, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TRAUMATIC STUPOR AND COMA <1 HOUR WITH CC", "code_information": [{"code": "086", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "maximum": 23962.08, "gross_charge": 28190.68, "discounted_cash": 16914.41, "minimum": 6027, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies and other services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs, supplies, and other services can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs, supplies, and other services can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs, supplies, and other services can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs, supplies, and other services can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs, supplies, and other services can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies and other services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs, supplies, and other services can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs, supplies, and other services can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies and other services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies and other services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies and other services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs, supplies, and other services can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TRAUMATIC STUPOR AND COMA <1 HOUR WITHOUT CC/MCC", "code_information": [{"code": "087", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 21968.89, "gross_charge": 25845.75, "discounted_cash": 15507.45, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CONCUSSION WITH MCC", "code_information": [{"code": "088", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "maximum": 45301.6, "gross_charge": 53296.0, "discounted_cash": 31977.6, "minimum": 7121, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 21996, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 10650, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 8681, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 14292, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 7121, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 8589, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 9761, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 21996, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 8810, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 8810, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 7121, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 8589, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 7121, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 8589, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 8810, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CONCUSSION WITH CC", "code_information": [{"code": "089", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 5031.2, "maximum": 24505.78, "gross_charge": 28830.33, "discounted_cash": 17298.2, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs, supplies, and other services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs, supplies, and other services can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs, supplies, and other services can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs, supplies, and other services can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs, supplies, and other services can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs, supplies, and other services can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs, supplies, and other services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs, supplies, and other services can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs, supplies, and other services can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs, supplies, and other services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs, supplies, and other services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs, supplies, and other services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs, supplies, and other services can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CONCUSSION WITHOUT CC/MCC", "code_information": [{"code": "090", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 22643.32, "gross_charge": 26639.2, "discounted_cash": 15983.52, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OTHER DISORDERS OF NERVOUS SYSTEM WITH MCC", "code_information": [{"code": "091", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 7121.0, "maximum": 40530.34, "gross_charge": 47682.75, "discounted_cash": 28609.65, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 21996, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10650, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8681, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 14292, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7121, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8589, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9761, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 21996, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8810, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8810, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7121, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8589, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7121, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8589, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8810, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OTHER DISORDERS OF NERVOUS SYSTEM WITH CC", "code_information": [{"code": "092", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 35884.15, "gross_charge": 42216.7, "discounted_cash": 25330.02, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OTHER DISORDERS OF NERVOUS SYSTEM WITHOUT CC/MCC", "code_information": [{"code": "093", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 20997.9, "gross_charge": 16137.0, "discounted_cash": 9682.2, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH MCC", "code_information": [{"code": "094", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6429.0, "maximum": 94490.55, "gross_charge": 80885.25, "discounted_cash": 48531.15, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 10075, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9714, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 11896, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 10461, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6429, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 8124, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 7197, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7392, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 11896, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 10075, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 9000, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 11896, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9714, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7011, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7011, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 10075, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 10075, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 10075, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 7197, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7392, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 7197, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7392, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7011, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 11896, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH CC", "code_information": [{"code": "095", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 7121.0, "maximum": 61024.41, "gross_charge": 71793.41, "discounted_cash": 43076.05, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 21996, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10650, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8681, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 14292, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7121, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8589, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9761, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 21996, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8810, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8810, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7121, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8589, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7121, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8589, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8810, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT CC/MCC", "code_information": [{"code": "096", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 115488.45, "gross_charge": 74575.1, "discounted_cash": 44745.06, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH MCC", "code_information": [{"code": "097", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 105989.4, "gross_charge": 118854.94, "discounted_cash": 71312.96, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH CC", "code_information": [{"code": "098", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6680.0, "maximum": 178206.61, "gross_charge": 210803.38, "discounted_cash": 126482.03, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 51.1, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 60.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITHOUT CC/MCC", "code_information": [{"code": "099", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 23046.0, "gross_charge": 24267.0, "discounted_cash": 14560.2, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SEIZURES WITH MCC", "code_information": [{"code": "100", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 100782.5, "gross_charge": 23513.9, "discounted_cash": 14108.34, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SEIZURES WITHOUT MCC", "code_information": [{"code": "101", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 4898.2, "maximum": 23240.85, "gross_charge": 14495.0, "discounted_cash": 8697.0, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HEADACHES WITH MCC", "code_information": [{"code": "102", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 25214.79, "gross_charge": 29664.45, "discounted_cash": 17798.67, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HEADACHES WITHOUT MCC", "code_information": [{"code": "103", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 21197.88, "gross_charge": 23370.85, "discounted_cash": 14022.51, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "EXTRAOCULAR PROCEDURES EXCEPT ORBIT", "code_information": [{"code": "115", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 33260.25, "gross_charge": 32973.0, "discounted_cash": 19783.8, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "INTRAOCULAR PROCEDURES WITH CC/MCC", "code_information": [{"code": "116", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 31496.85, "gross_charge": 29324.9, "discounted_cash": 17594.94, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 21996, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 14292, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 21996, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ACUTE MAJOR EYE INFECTIONS WITH CC/MCC", "code_information": [{"code": "121", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 21197.88, "gross_charge": 24353.7, "discounted_cash": 14612.22, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ACUTE MAJOR EYE INFECTIONS WITHOUT CC/MCC", "code_information": [{"code": "122", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 15700.23, "gross_charge": 18470.85, "discounted_cash": 11082.51, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "NEUROLOGICAL EYE DISORDERS", "code_information": [{"code": "123", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "maximum": 49342.54, "gross_charge": 58050.05, "discounted_cash": 34830.03, "minimum": 6027, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OTHER DISORDERS OF THE EYE WITH MCC OR THROMBOLYTIC AGENT", "code_information": [{"code": "124", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 3532.0, "maximum": 304469.55, "gross_charge": 174551.75, "discounted_cash": 104731.05, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 6994, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 5676, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 6387, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 3768, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 3869, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 6994, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 60.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 5676, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 3532, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 3532, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 6994, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 6994, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 6994, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 3768, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 3869, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 3768, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 3869, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 3532, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OTHER DISORDERS OF THE EYE WITHOUT MCC", "code_information": [{"code": "125", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 23120.13, "gross_charge": 27200.15, "discounted_cash": 16320.09, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SINUS AND MASTOID PROCEDURES WITH CC/MCC", "code_information": [{"code": "135", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "maximum": 128118.08, "gross_charge": 150868.15, "discounted_cash": 90520.89, "minimum": 6680, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 79.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MOUTH PROCEDURES WITH CC/MCC", "code_information": [{"code": "137", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 7121.0, "maximum": 52378.53, "gross_charge": 61621.8, "discounted_cash": 36973.08, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 21996, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10650, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8681, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 14292, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7121, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8589, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9761, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 21996, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8810, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8810, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7121, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8589, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7121, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8589, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8810, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MOUTH PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "138", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "maximum": 10498.95, "gross_charge": 6876.0, "discounted_cash": 4125.6, "minimum": 6027, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MAJOR HEAD AND NECK PROCEDURES WITH MCC", "code_information": [{"code": "140", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "maximum": 52494.75, "gross_charge": 41794.36, "discounted_cash": 25076.62, "minimum": 6027, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MAJOR HEAD AND NECK PROCEDURES WITH CC", "code_information": [{"code": "141", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 54369.03, "gross_charge": 63963.55, "discounted_cash": 38378.13, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs, supplies, and other services can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MAJOR HEAD AND NECK PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "142", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 75548.29, "gross_charge": 88882.63, "discounted_cash": 53329.58, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional anesthesia services, supplies, and other services can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs, labs, and supplies can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH MCC", "code_information": [{"code": "143", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6680.0, "maximum": 241475.85, "gross_charge": 227217.85, "discounted_cash": 136330.71, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 21996, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 51.1, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 60.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 21996, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH CC", "code_information": [{"code": "144", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 22164.86, "gross_charge": 26138.1, "discounted_cash": 15682.86, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "145", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 24374.16, "gross_charge": 28675.48, "discounted_cash": 17205.29, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH CC", "code_information": [{"code": "147", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 39708.27, "gross_charge": 46719.51, "discounted_cash": 28031.71, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITHOUT CC/MCC", "code_information": [{"code": "148", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 5968.1, "maximum": 10598.94, "gross_charge": 12305.35, "discounted_cash": 7383.21, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DYSEQUILIBRIUM", "code_information": [{"code": "149", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 20997.9, "gross_charge": 15500.0, "discounted_cash": 9300.0, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OTITIS MEDIA AND URI WITH MCC", "code_information": [{"code": "152", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 41995.8, "gross_charge": 24536.62, "discounted_cash": 14721.97, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OTITIS MEDIA AND URI WITHOUT MCC", "code_information": [{"code": "153", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 2694.05, "maximum": 21996.0, "gross_charge": 14923.9, "discounted_cash": 8954.34, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 20827, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 21996, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 12391, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 10650, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 8681, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 14292, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 7121, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 8589, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 12391, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 20827, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 9761, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 12391, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 21996, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 8810, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 8810, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 20827, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 20827, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 20827, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 7121, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 8589, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 7121, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 8589, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 8810, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 12391, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH MCC", "code_information": [{"code": "154", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 104989.5, "gross_charge": 87733.2, "discounted_cash": 52639.92, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 21996, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 21996, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH CC", "code_information": [{"code": "155", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 31496.85, "gross_charge": 23587.2, "discounted_cash": 14152.32, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITHOUT CC/MCC", "code_information": [{"code": "156", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 20997.9, "gross_charge": 20982.35, "discounted_cash": 12589.41, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DENTAL AND ORAL DISEASES WITH MCC", "code_information": [{"code": "157", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 38116.08, "gross_charge": 44843.79, "discounted_cash": 26906.27, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies and other services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies and other services can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies and other services can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies and other services can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies and other services can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies and other services can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies and other services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies and other services can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies and other services can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies and other services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies and other services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies and other services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies and other services can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DENTAL AND ORAL DISEASES WITH CC", "code_information": [{"code": "158", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 41995.8, "gross_charge": 24210.0, "discounted_cash": 14526.0, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DENTAL AND ORAL DISEASES WITHOUT CC/MCC", "code_information": [{"code": "159", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "maximum": 31496.85, "gross_charge": 19474.0, "discounted_cash": 11684.4, "minimum": 6027, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MAJOR CHEST PROCEDURES WITH MCC", "code_information": [{"code": "163", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6844.0, "maximum": 123089.2, "gross_charge": 144827.02, "discounted_cash": 86896.21, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 50885, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 9888, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 9956, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6844, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 8804, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 9888, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 50885, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 8500, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 9888, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 8267, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 8267, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 50885, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 50885, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 50885, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6844, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 8804, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6844, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 8804, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 8267, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 9888, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MAJOR CHEST PROCEDURES WITH CC", "code_information": [{"code": "164", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 55205.92, "gross_charge": 65522.19, "discounted_cash": 39313.31, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_dollar": 50885, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_dollar": 50885, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_dollar": 50885, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_dollar": 50885, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_dollar": 50885, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MAJOR CHEST PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "165", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 73885.62, "gross_charge": 74852.52, "discounted_cash": 44911.51, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 50885, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 50885, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 50885, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 50885, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 50885, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH MCC", "code_information": [{"code": "166", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 10481.0, "maximum": 649134.72, "gross_charge": 319454.25, "discounted_cash": 191672.55, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10481, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 51.1, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 59.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 60.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10481, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 59.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 59.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH CC", "code_information": [{"code": "167", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 7121.0, "maximum": 94269.51, "gross_charge": 110905.3, "discounted_cash": 66543.18, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 21996, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 10650, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 8681, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7121, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8589, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9761, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 21996, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8810, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8810, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7121, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8589, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7121, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8589, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8810, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "168", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "maximum": 31908.46, "gross_charge": 37540.97, "discounted_cash": 22524.58, "minimum": 6027, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PULMONARY EMBOLISM WITH MCC OR ACUTE COR PULMONALE", "code_information": [{"code": "175", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 73264.82, "gross_charge": 86193.9, "discounted_cash": 51716.34, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PULMONARY EMBOLISM WITHOUT MCC", "code_information": [{"code": "176", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 7121.0, "maximum": 49947.43, "gross_charge": 27298.45, "discounted_cash": 16379.07, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 21996, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10650, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8681, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 14292, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7121, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8589, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9761, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 21996, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8810, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8810, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7121, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8589, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7121, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8589, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8810, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC", "code_information": [{"code": "177", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 63593.64, "gross_charge": 72913.1, "discounted_cash": 43747.86, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH CC", "code_information": [{"code": "178", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 7121.0, "maximum": 22102.04, "gross_charge": 26002.4, "discounted_cash": 15601.44, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 21996, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10650, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8681, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 14292, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7121, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8589, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9761, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 21996, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8810, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8810, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7121, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8589, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7121, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8589, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8810, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "RESPIRATORY INFECTIONS AND INFLAMMATIONS WITHOUT CC/MCC", "code_information": [{"code": "179", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 20997.9, "gross_charge": 17373.0, "discounted_cash": 10423.8, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional radiology services and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional radiology services and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional radiology services and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional radiology services and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional radiology services and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional radiology services and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional radiology services and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional radiology services and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional radiology services and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional radiology services and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional radiology services and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional radiology services and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional radiology services and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional radiology services and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional radiology services and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional radiology services and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional radiology services and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional radiology services and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional radiology services and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional radiology services and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional radiology services and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional radiology services and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional radiology services and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional radiology services and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional radiology services and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional radiology services and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional radiology services and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional radiology services and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional radiology services and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional radiology services and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional radiology services and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional radiology services and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional radiology services and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional radiology services and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional radiology services and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional radiology services and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional radiology services and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional radiology services and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "RESPIRATORY NEOPLASMS WITH MCC", "code_information": [{"code": "180", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 7121.0, "maximum": 39214.54, "gross_charge": 46134.75, "discounted_cash": 27680.85, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 21996, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10650, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8681, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 14292, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7121, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8589, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9761, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 21996, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8810, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8810, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7121, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8589, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7121, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8589, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8810, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "RESPIRATORY NEOPLASMS WITH CC", "code_information": [{"code": "181", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "maximum": 52494.75, "gross_charge": 43854.5, "discounted_cash": 26312.7, "minimum": 6027, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 21996, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 21996, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PLEURAL EFFUSION WITH MCC", "code_information": [{"code": "186", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6370.0, "maximum": 42395.76, "gross_charge": 49104.67, "discounted_cash": 29462.8, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 11276, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9888, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9956, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6370, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7660, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6844, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8804, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9888, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 11276, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8500, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9888, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8267, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8267, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 11276, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 11276, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 11276, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6844, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8804, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6844, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8804, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8267, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9888, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PLEURAL EFFUSION WITH CC", "code_information": [{"code": "187", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "maximum": 136486.35, "gross_charge": 107697.87, "discounted_cash": 64618.72, "minimum": 6027, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PULMONARY EDEMA AND RESPIRATORY FAILURE", "code_information": [{"code": "189", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 7121.0, "maximum": 33133.47, "gross_charge": 38983.85, "discounted_cash": 23390.31, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 20827, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 21996, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 12391, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 10650, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 8681, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 14292, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 7121, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 8589, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 12391, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 20827, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 9761, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 12391, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 21996, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 8810, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 8810, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 20827, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 20827, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 20827, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 7121, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 8589, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 7121, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 8589, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 8810, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 12391, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC", "code_information": [{"code": "191", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 39577.66, "gross_charge": 46561.95, "discounted_cash": 27937.17, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CC/MCC", "code_information": [{"code": "192", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "maximum": 52994.7, "gross_charge": 53023.93, "discounted_cash": 31814.36, "minimum": 6027, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SIMPLE PNEUMONIA AND PLEURISY WITH MCC", "code_information": [{"code": "193", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 7003.73, "maximum": 35721.81, "gross_charge": 42025.65, "discounted_cash": 25215.39, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 21996, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10650, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8681, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 14292, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7121, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8589, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9761, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 21996, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8810, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8810, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7121, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8589, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7121, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8589, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8810, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SIMPLE PNEUMONIA AND PLEURISY WITH CC", "code_information": [{"code": "194", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 7121.0, "maximum": 21996.0, "gross_charge": 18678.15, "discounted_cash": 11206.89, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 20827, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 21996, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 12391, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 10650, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 8681, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 14292, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 7121, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 8589, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 12391, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 20827, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 9761, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 12391, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 21996, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 8810, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 8810, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 20827, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 20827, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 20827, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 7121, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 8589, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 7121, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 8589, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 8810, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 12391, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SIMPLE PNEUMONIA AND PLEURISY WITHOUT CC/MCC", "code_information": [{"code": "195", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 4719.37, "maximum": 12281.65, "gross_charge": 14449.0, "discounted_cash": 8669.4, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "INTERSTITIAL LUNG DISEASE WITH MCC", "code_information": [{"code": "196", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "maximum": 83991.6, "gross_charge": 52402.8, "discounted_cash": 31441.68, "minimum": 6027, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "INTERSTITIAL LUNG DISEASE WITH CC", "code_information": [{"code": "197", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "maximum": 136486.35, "gross_charge": 100748.95, "discounted_cash": 60449.37, "minimum": 6027, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "INTERSTITIAL LUNG DISEASE WITHOUT CC/MCC", "code_information": [{"code": "198", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 62993.7, "gross_charge": 46708.85, "discounted_cash": 28025.31, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PNEUMOTHORAX WITH MCC", "code_information": [{"code": "199", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 7121.0, "maximum": 21996.0, "gross_charge": 23068.0, "discounted_cash": 13840.8, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 20827, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 21996, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 12391, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 10650, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 8681, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 14292, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 7121, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 8589, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 12391, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 20827, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 9761, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 12391, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 21996, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 8810, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 8810, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 20827, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 20827, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 20827, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 7121, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 8589, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 7121, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 8589, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 8810, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 12391, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PNEUMOTHORAX WITH CC", "code_information": [{"code": "200", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 26296.67, "gross_charge": 30937.25, "discounted_cash": 18562.35, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PNEUMOTHORAX WITHOUT CC/MCC", "code_information": [{"code": "201", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 28156.85, "gross_charge": 18692.9, "discounted_cash": 11215.74, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "BRONCHITIS AND ASTHMA WITH CC/MCC", "code_information": [{"code": "202", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 7121.0, "maximum": 24434.7, "gross_charge": 28746.7, "discounted_cash": 17248.02, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 21996, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10650, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8681, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 14292, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7121, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8589, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9761, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 21996, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8810, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8810, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7121, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8589, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7121, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8589, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8810, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "BRONCHITIS AND ASTHMA WITHOUT CC/MCC", "code_information": [{"code": "203", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 20997.9, "gross_charge": 14332.5, "discounted_cash": 8599.5, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and therapy services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and therapy services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and therapy services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and therapy services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and therapy services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "RESPIRATORY SIGNS AND SYMPTOMS", "code_information": [{"code": "204", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 10598.94, "gross_charge": 12441.6, "discounted_cash": 7464.96, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OTHER RESPIRATORY SYSTEM DIAGNOSES WITH MCC", "code_information": [{"code": "205", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6370.0, "maximum": 41995.8, "gross_charge": 37446.95, "discounted_cash": 22468.17, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 11276, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 21996, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9888, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9956, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6370, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7660, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6844, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8804, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9888, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 11276, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8500, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9888, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 21996, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8267, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8267, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 11276, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 11276, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 11276, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6844, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8804, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6844, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8804, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8267, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9888, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT MCC", "code_information": [{"code": "206", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 21197.88, "gross_charge": 21840.55, "discounted_cash": 13104.33, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS", "code_information": [{"code": "207", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 20827.0, "maximum": 214241.18, "gross_charge": 252048.45, "discounted_cash": 151229.07, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 21996, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 51.1, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 59.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 60.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 21996, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 59.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 59.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS", "code_information": [{"code": "208", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 51150.28, "gross_charge": 60542.95, "discounted_cash": 36325.77, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 20827, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 21996, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 14292, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 20827, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 21996, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 20827, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 20827, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 20827, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC", "code_information": [{"code": "216", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 10481.0, "maximum": 1340977.29, "gross_charge": 1577937.33, "discounted_cash": 946762.4, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 10481, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 51.1, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 59.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 60.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 10481, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 77137, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 77137, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 59.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 59.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 77137, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH MCC", "code_information": [{"code": "219", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 82604.0, "maximum": 253494.04, "gross_charge": 298228.27, "discounted_cash": 178936.96, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "other", "standard_charge_algorithm": "Additional services priced at per diem. May include reimbursement for certain add-on services.", "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 104030, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 120066, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 82604, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 84.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 94437, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 110230, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 104030, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 98500, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 104030, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "other", "standard_charge_algorithm": "Additional services priced at per diem. May include reimbursement for certain add-on services.", "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 88709, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 88709, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 94437, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 110230, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 94437, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 110230, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 88709, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 104030, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH CC", "code_information": [{"code": "220", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 7121.0, "maximum": 180997.21, "gross_charge": 212937.9, "discounted_cash": 127762.74, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 126510, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 21996, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 51.1, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7121, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8804, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 126510, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 60.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 21996, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 88709, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 88709, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 126510, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 126510, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 126510, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7121, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8804, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7121, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8804, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 88709, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OTHER CARDIOTHORACIC PROCEDURES WITH MCC", "code_information": [{"code": "228", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 10481.0, "maximum": 305255.43, "gross_charge": 359124.02, "discounted_cash": 215474.41, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 10481, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 51.1, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 59.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 60.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 10481, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 107373, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 107373, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 59.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 59.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 107373, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OTHER CARDIOTHORACIC PROCEDURES WITHOUT MCC", "code_information": [{"code": "229", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 39996.0, "maximum": 161470.0, "gross_charge": 159989.08, "discounted_cash": 95993.45, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_dollar": 146412, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "other", "standard_charge_algorithm": "May include reimbursement for certain add-on services.", "standard_charge_dollar": 161470, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 126843, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 134071, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 98890, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 84.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 105245, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 110104, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 126843, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_dollar": 146412, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 109635, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 126843, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "other", "standard_charge_algorithm": "May include reimbursement for certain add-on services.", "standard_charge_dollar": 161470, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 107373, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 107373, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_dollar": 146412, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_dollar": 146412, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_dollar": 146412, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 105245, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 110104, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 105245, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 110104, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 107373, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 126843, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PERMANENT CARDIAC PACEMAKER IMPLANT WITH MCC", "code_information": [{"code": "242", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 26397.0, "maximum": 96480.0, "gross_charge": 82302.54, "discounted_cash": 49381.52, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 41059, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "other", "standard_charge_algorithm": "May include reimbursement for certain add-on services.", "standard_charge_dollar": 96480, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 35024, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 30804, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 26397, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 84.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 26598, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 28699, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 35024, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 41059, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 29990, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 35024, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "other", "standard_charge_algorithm": "May include reimbursement for certain add-on services.", "standard_charge_dollar": 96480, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 29371, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 29371, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 41059, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 41059, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 41059, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 26598, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 28699, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 26598, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 28699, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 29371, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 35024, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT CC/MCC", "code_information": [{"code": "244", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "maximum": 79854.02, "gross_charge": 93945.89, "discounted_cash": 56367.53, "minimum": 6027, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 41059, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 41059, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 29371, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 29371, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 41059, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 41059, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 41059, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 29371, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OTHER VASCULAR PROCEDURES WITH MCC", "code_information": [{"code": "252", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 17281.0, "maximum": 120527.0, "gross_charge": 116379.1, "discounted_cash": 69827.46, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 83320, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "other", "standard_charge_algorithm": "May include reimbursement for certain add-on services.", "standard_charge_dollar": 120527, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 22928, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 21777, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 17281, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 79437, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 86711, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 22928, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 83320, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 41190, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 22928, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "other", "standard_charge_algorithm": "May include reimbursement for certain add-on services.", "standard_charge_dollar": 120527, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 19228, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 19228, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 83320, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 83320, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 83320, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 79437, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 86711, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 79437, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 86711, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 19228, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 22928, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OTHER VASCULAR PROCEDURES WITH CC", "code_information": [{"code": "253", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "maximum": 109047.0, "gross_charge": 78055.94, "discounted_cash": 46833.56, "minimum": 6485, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 83320, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "other", "standard_charge_algorithm": "May include reimbursement for certain add-on services.", "standard_charge_dollar": 109047, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 22928, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 21777, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 17281, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 79437, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 86711, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 22928, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 83320, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 41190, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 22928, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "other", "standard_charge_algorithm": "May include reimbursement for certain add-on services.", "standard_charge_dollar": 109047, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 19228, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 19228, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 83320, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 83320, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 83320, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 79437, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 86711, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 79437, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 86711, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 19228, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 22928, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OTHER VASCULAR PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "254", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "maximum": 109047.0, "gross_charge": 124971.65, "discounted_cash": 74982.99, "minimum": 17281, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 83320, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "other", "standard_charge_algorithm": "May include reimbursement for certain add-on services.", "standard_charge_dollar": 109047, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 22928, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 21777, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 17281, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 79.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 79437, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 86711, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 22928, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 83320, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 41190, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 22928, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "other", "standard_charge_algorithm": "May include reimbursement for certain add-on services.", "standard_charge_dollar": 109047, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 19228, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 19228, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 83320, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 83320, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 83320, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 79437, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 86711, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 79437, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 86711, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 19228, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 22928, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH CC", "code_information": [{"code": "256", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 10481.0, "maximum": 332664.82, "gross_charge": 391370.38, "discounted_cash": 234822.23, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 10481, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 51.1, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 59.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 60.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 10481, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 59.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 59.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT MCC", "code_information": [{"code": "259", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 65247.61, "gross_charge": 76761.88, "discounted_cash": 46057.13, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 25128, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs, supplies, and other services can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs, labs, and supplies can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 25128, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 17480, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 17480, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 25128, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 25128, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 25128, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 17480, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH MCC", "code_information": [{"code": "260", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 15710.0, "maximum": 123331.17, "gross_charge": 145142.64, "discounted_cash": 87085.58, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 57247, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "other", "standard_charge_algorithm": "May include reimbursement for certain add-on services.", "standard_charge_dollar": 53741, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 20843, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 21826, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 15710, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 84.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 19353, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 23491, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 20843, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 57247, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 17848, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 20843, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "other", "standard_charge_algorithm": "May include reimbursement for certain add-on services.", "standard_charge_dollar": 53741, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 17480, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 17480, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 57247, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 57247, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 57247, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 19353, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 23491, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 19353, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 23491, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 17480, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 20843, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH CC", "code_information": [{"code": "261", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 15710.0, "maximum": 86177.84, "gross_charge": 101453.89, "discounted_cash": 60872.33, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 57247, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "other", "standard_charge_algorithm": "May include reimbursement for certain add-on services.", "standard_charge_dollar": 48622, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 20843, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 21826, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 15710, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 84.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 19353, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 23491, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 20843, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 57247, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 17848, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 20843, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "other", "standard_charge_algorithm": "May include reimbursement for certain add-on services.", "standard_charge_dollar": 48622, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 17480, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 17480, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 57247, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 57247, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 57247, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 19353, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 23491, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 19353, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 23491, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 17480, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 20843, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT CC/MCC", "code_information": [{"code": "262", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 15710.0, "maximum": 57247.0, "gross_charge": 51119.14, "discounted_cash": 30671.48, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 57247, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "other", "standard_charge_algorithm": "May include reimbursement for certain add-on services.", "standard_charge_dollar": 48622, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 20843, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 21826, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 15710, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 84.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 19353, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 23491, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 20843, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 57247, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 17848, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 20843, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "other", "standard_charge_algorithm": "May include reimbursement for certain add-on services.", "standard_charge_dollar": 48622, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 17480, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 17480, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 57247, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 57247, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 57247, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 19353, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 23491, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 19353, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 23491, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 17480, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 20843, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OTHER CIRCULATORY SYSTEM O.R. PROCEDURES", "code_information": [{"code": "264", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6620.0, "maximum": 293970.6, "gross_charge": 268071.03, "discounted_cash": 160842.62, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 51.1, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 59.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 60.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 59.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 59.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITH MCC", "code_information": [{"code": "266", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 9999.0, "maximum": 419743.0, "gross_charge": 194325.96, "discounted_cash": 116595.58, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 94956, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "other", "standard_charge_algorithm": "May include reimbursement for certain add-on services.", "standard_charge_dollar": 419743, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 106134, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 111137, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 80819, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 84.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 100485, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 120713, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 106134, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 94956, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 90880, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 106134, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "other", "standard_charge_algorithm": "May include reimbursement for certain add-on services.", "standard_charge_dollar": 419743, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 89006, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 89006, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 94956, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 94956, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 94956, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 100485, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 120713, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 100485, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 120713, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 89006, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 106134, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITHOUT MCC", "code_information": [{"code": "267", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 9999.0, "maximum": 419743.0, "gross_charge": 186351.25, "discounted_cash": 111810.75, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 94956, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "other", "standard_charge_algorithm": "May include reimbursement for certain add-on services.", "standard_charge_dollar": 419743, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 106134, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 111137, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 80819, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 84.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 100485, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 120713, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 106134, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 94956, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 90880, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 106134, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "other", "standard_charge_algorithm": "May include reimbursement for certain add-on services.", "standard_charge_dollar": 419743, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 89006, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 89006, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 94956, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 94956, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 94956, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 100485, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 120713, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 100485, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 120713, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 89006, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 106134, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH MCC", "code_information": [{"code": "268", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 71701.0, "maximum": 187665.69, "gross_charge": 220971.36, "discounted_cash": 132582.82, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_dollar": 94335, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "other", "standard_charge_algorithm": "May include reimbursement for certain add-on services.", "standard_charge_dollar": 175200, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 95131, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 99617, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 71701, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 84.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 90069, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 89060, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 95131, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_dollar": 94335, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 81459, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 95131, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "other", "standard_charge_algorithm": "May include reimbursement for certain add-on services.", "standard_charge_dollar": 175200, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 79780, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 79780, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_dollar": 94335, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_dollar": 94335, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_dollar": 94335, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 90069, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 89060, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 90069, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 89060, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 79780, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 95131, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC", "code_information": [{"code": "269", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 39996.0, "maximum": 175200.0, "gross_charge": 100033.25, "discounted_cash": 60019.95, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 94335, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "other", "standard_charge_algorithm": "May include reimbursement for certain add-on services.", "standard_charge_dollar": 175200, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 95131, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 99617, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 71701, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 84.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 90069, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 89060, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 95131, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 94335, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 81459, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 95131, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "other", "standard_charge_algorithm": "May include reimbursement for certain add-on services.", "standard_charge_dollar": 175200, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 79780, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 79780, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 94335, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 94335, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 94335, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 90069, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 89060, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 90069, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 89060, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 79780, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 95131, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH MCC", "code_information": [{"code": "270", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 10481.0, "maximum": 305626.54, "gross_charge": 359560.62, "discounted_cash": 215736.37, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 10481, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 51.1, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 59.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 60.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 10481, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 69992, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 69992, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 59.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 59.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 69992, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH CC", "code_information": [{"code": "271", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 19998.0, "maximum": 156932.0, "gross_charge": 110109.21, "discounted_cash": 66065.53, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 94335, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "other", "standard_charge_algorithm": "May include reimbursement for certain add-on services.", "standard_charge_dollar": 156932, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 86012, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 87398, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 63235, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 84.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 79020, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 85840, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 86012, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 94335, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 79995, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 86012, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "other", "standard_charge_algorithm": "May include reimbursement for certain add-on services.", "standard_charge_dollar": 156932, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 69992, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 69992, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 94335, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 94335, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 94335, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 79020, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 85840, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 79020, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 85840, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 69992, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 86012, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OTHER MAJOR CARDIOVASCULAR PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "272", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "maximum": 311569.57, "gross_charge": 311450.42, "discounted_cash": 186870.25, "minimum": 63235, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_dollar": 94335, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "other", "standard_charge_algorithm": "May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 141985, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_dollar": 86012, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_dollar": 87398, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_dollar": 63235, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 84.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 79020, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 85840, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_dollar": 86012, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_dollar": 94335, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_dollar": 79995, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_dollar": 86012, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "other", "standard_charge_algorithm": "May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 141985, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 69992, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 69992, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_dollar": 94335, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_dollar": 94335, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_dollar": 94335, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 79020, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 85840, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 79020, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 85840, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 69992, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_dollar": 86012, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITH MCC", "code_information": [{"code": "273", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 21996.0, "maximum": 354251.29, "gross_charge": 268153.98, "discounted_cash": 160892.39, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 79814, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 21996, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 51.1, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 59.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 79814, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 60.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 21996, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 29864, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 29864, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 79814, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 79814, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 79814, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 59.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 59.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 29864, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITHOUT MCC", "code_information": [{"code": "274", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 19998.0, "maximum": 92148.0, "gross_charge": 106318.14, "discounted_cash": 63790.88, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 79814, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "other", "standard_charge_algorithm": "May include reimbursement for certain add-on services.", "standard_charge_dollar": 92148, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 35610, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 37290, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 26839, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 84.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 33714, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 38197, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 35610, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 79814, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 42422, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 35610, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "other", "standard_charge_algorithm": "May include reimbursement for certain add-on services.", "standard_charge_dollar": 92148, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 29864, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 29864, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 79814, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 79814, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 79814, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 33714, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 38197, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 33714, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 38197, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 29864, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 35610, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CARDIAC DEFIBRILLATOR IMPLANT WITH MCC OR CAROTID SINUS NEUROSTIMULATOR", "code_information": [{"code": "276", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 9657.0, "maximum": 184390.36, "gross_charge": 209203.94, "discounted_cash": 125522.36, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 149326, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "other", "standard_charge_algorithm": "May include reimbursement for certain add-on services.", "standard_charge_dollar": 160601, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs, supplies, and other services can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 103675, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 110585, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 149326, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 60.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "other", "standard_charge_algorithm": "May include reimbursement for certain add-on services.", "standard_charge_dollar": 160601, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 95505, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 95505, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 149326, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 149326, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 149326, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 103675, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 110585, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 103675, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 110585, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 95505, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CARDIAC DEFIBRILLATOR IMPLANT WITHOUT MCC", "code_information": [{"code": "277", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6370.0, "maximum": 160601.0, "gross_charge": 195596.25, "discounted_cash": 117357.75, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 149326, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "other", "standard_charge_algorithm": "May include reimbursement for certain add-on services.", "standard_charge_dollar": 160601, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 9888, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs, supplies, and other services can be included in reimbursement.", "standard_charge_dollar": 9956, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 6370, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 103675, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 110585, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 9888, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 149326, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 60.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 9888, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "other", "standard_charge_algorithm": "May include reimbursement for certain add-on services.", "standard_charge_dollar": 160601, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 95505, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 95505, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 149326, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 149326, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 149326, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 103675, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 110585, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 103675, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 110585, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 95505, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 9888, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITH MCC", "code_information": [{"code": "286", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 91909.53, "gross_charge": 122665.91, "discounted_cash": 73599.55, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_dollar": 61045, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional radiology services and other services can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_dollar": 61045, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 28112, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 28112, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_dollar": 61045, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_dollar": 61045, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_dollar": 61045, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 28112, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITHOUT MCC", "code_information": [{"code": "287", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 25266.0, "maximum": 139863.0, "gross_charge": 126807.97, "discounted_cash": 76084.78, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 61045, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "other", "standard_charge_algorithm": "May include reimbursement for certain add-on services.", "standard_charge_dollar": 139863, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 33521, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 35104, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 25266, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 84.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 31126, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 33573, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 33521, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 61045, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 28704, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 33521, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "other", "standard_charge_algorithm": "May include reimbursement for certain add-on services.", "standard_charge_dollar": 139863, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 28112, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 28112, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 61045, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 61045, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 61045, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 31126, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 33573, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 31126, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 33573, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 28112, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 33521, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HEART FAILURE AND SHOCK WITH MCC", "code_information": [{"code": "291", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "maximum": 53057.11, "gross_charge": 62420.11, "discounted_cash": 37452.07, "minimum": 14292, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 26047, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and supplies can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and supplies can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and supplies can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and supplies can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "other", "standard_charge_algorithm": "May include reimbursement for certain add-on services.", "standard_charge_dollar": 33663, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 26934, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 26691, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 20302, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 14292, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 24521, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 26638, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and supplies can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and supplies can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and supplies can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and supplies can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 26934, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and supplies can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and supplies can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and supplies can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 26047, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 23064, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and supplies can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and supplies can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and supplies can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and supplies can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 26934, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and supplies can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and supplies can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and supplies can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and supplies can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "other", "standard_charge_algorithm": "May include reimbursement for certain add-on services.", "standard_charge_dollar": 33663, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 22588, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 22588, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and supplies can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and supplies can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 26047, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 26047, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 26047, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and supplies can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and supplies can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 24521, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 26638, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and supplies can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and supplies can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and supplies can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and supplies can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and supplies can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and supplies can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and supplies can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 24521, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 26638, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and supplies can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and supplies can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and supplies can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 22588, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 26934, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and supplies can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and supplies can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and supplies can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and supplies can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and supplies can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HEART FAILURE AND SHOCK WITH CC", "code_information": [{"code": "292", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 9644.37, "maximum": 33663.0, "gross_charge": 26648.7, "discounted_cash": 15989.22, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 26047, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "other", "standard_charge_algorithm": "May include reimbursement for certain add-on services.", "standard_charge_dollar": 33663, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 26934, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 26691, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 20302, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 14292, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 24521, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 26638, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 26934, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 26047, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 23064, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 26934, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "other", "standard_charge_algorithm": "May include reimbursement for certain add-on services.", "standard_charge_dollar": 33663, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 22588, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 22588, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 26047, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 26047, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 26047, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 24521, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 26638, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 24521, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 26638, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 22588, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 26934, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HEART FAILURE AND SHOCK WITHOUT CC/MCC", "code_information": [{"code": "293", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 9644.37, "maximum": 33663.0, "gross_charge": 26648.7, "discounted_cash": 15989.22, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 26047, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "other", "standard_charge_algorithm": "May include reimbursement for certain add-on services.", "standard_charge_dollar": 33663, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 26934, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 26691, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 20302, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 14292, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 24521, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 26638, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 26934, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 26047, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 23064, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 26934, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "other", "standard_charge_algorithm": "May include reimbursement for certain add-on services.", "standard_charge_dollar": 33663, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 22588, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 22588, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 26047, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 26047, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 26047, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 24521, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 26638, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 24521, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 26638, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 22588, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 26934, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CARDIAC ARREST, UNEXPLAINED WITH MCC", "code_information": [{"code": "296", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "maximum": 99167.97, "gross_charge": 116668.2, "discounted_cash": 70000.92, "minimum": 6680, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 21996, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10650, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8681, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9761, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 21996, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8810, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8810, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8810, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PERIPHERAL VASCULAR DISORDERS WITH MCC", "code_information": [{"code": "299", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 58089.77, "gross_charge": 68340.9, "discounted_cash": 41004.54, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PERIPHERAL VASCULAR DISORDERS WITH CC", "code_information": [{"code": "300", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 5550.0, "maximum": 41995.8, "gross_charge": 29740.55, "discounted_cash": 17844.33, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PERIPHERAL VASCULAR DISORDERS WITHOUT CC/MCC", "code_information": [{"code": "301", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 41995.8, "gross_charge": 34940.1, "discounted_cash": 20964.06, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HYPERTENSION WITH MCC", "code_information": [{"code": "304", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "maximum": 42721.77, "gross_charge": 50249.5, "discounted_cash": 30149.7, "minimum": 7121, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 20827, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 21996, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 12391, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 10650, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 8681, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 14292, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 7121, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 8589, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 12391, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 20827, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 9761, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 12391, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 21996, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 8810, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 8810, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 20827, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 20827, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 20827, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 7121, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 8589, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 7121, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 8589, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 8810, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 12391, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HYPERTENSION WITHOUT MCC", "code_information": [{"code": "305", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "maximum": 12308.68, "gross_charge": 14480.8, "discounted_cash": 8688.48, "minimum": 6027, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CARDIAC CONGENITAL AND VALVULAR DISORDERS WITH MCC", "code_information": [{"code": "306", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 7121.0, "maximum": 124245.06, "gross_charge": 146311.65, "discounted_cash": 87786.99, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 22826, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 21996, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_dollar": 10650, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7121, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8589, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 22826, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_dollar": 9761, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 21996, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 22407, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 22407, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 22826, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 22826, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 22826, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7121, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8589, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7121, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8589, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 22407, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CARDIAC CONGENITAL AND VALVULAR DISORDERS WITHOUT MCC", "code_information": [{"code": "307", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6680.0, "maximum": 31496.85, "gross_charge": 23172.15, "discounted_cash": 13903.29, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 22826, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 26719, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 20003, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 20139, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 84.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 26719, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 22826, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 22879, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 26719, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 22407, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 22407, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 22826, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 22826, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 22826, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 22407, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 26719, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC", "code_information": [{"code": "308", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 7121.0, "maximum": 52994.7, "gross_charge": 61081.4, "discounted_cash": 36648.84, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 22826, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 21996, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 10650, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8681, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 14292, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7121, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8589, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 22826, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9761, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 21996, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 37896, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 37896, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 22826, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 22826, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 22826, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7121, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8589, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7121, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8589, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 37896, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC", "code_information": [{"code": "309", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 9221.0, "maximum": 55783.35, "gross_charge": 34071.45, "discounted_cash": 20442.87, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_dollar": 22826, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 45189, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 45886, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 34059, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 84.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 40343, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 43278, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 45189, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_dollar": 22826, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 38694, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 45189, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 37896, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 37896, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_dollar": 22826, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_dollar": 22826, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_dollar": 22826, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 40343, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 43278, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 40343, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 43278, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 37896, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 45189, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CC/MCC", "code_information": [{"code": "310", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 7048.52, "maximum": 64763.5, "gross_charge": 14533.0, "discounted_cash": 8719.8, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_dollar": 22826, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 45189, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 45886, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 34059, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 84.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 40343, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 43278, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 45189, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_dollar": 22826, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 38694, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 45189, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 37896, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 37896, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_dollar": 22826, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_dollar": 22826, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_dollar": 22826, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 40343, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 43278, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 40343, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 43278, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 37896, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 45189, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SYNCOPE AND COLLAPSE", "code_information": [{"code": "312", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 31496.85, "gross_charge": 20673.0, "discounted_cash": 12403.8, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CHEST PAIN", "code_information": [{"code": "313", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "maximum": 31496.85, "gross_charge": 22259.9, "discounted_cash": 13355.94, "minimum": 6027, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OTHER CIRCULATORY SYSTEM DIAGNOSES WITH MCC", "code_information": [{"code": "314", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 146985.3, "gross_charge": 107843.3, "discounted_cash": 64705.98, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OTHER CIRCULATORY SYSTEM DIAGNOSES WITH CC", "code_information": [{"code": "315", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 62993.7, "gross_charge": 47605.65, "discounted_cash": 28563.39, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OTHER CIRCULATORY SYSTEM DIAGNOSES WITHOUT CC/MCC", "code_information": [{"code": "316", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 20997.9, "gross_charge": 14253.15, "discounted_cash": 8551.89, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITHOUT MCC", "code_information": [{"code": "320", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6485.0, "maximum": 128840.0, "gross_charge": 55286.34, "discounted_cash": 33171.8, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 101602, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "other", "standard_charge_algorithm": "May include reimbursement for certain add-on services.", "standard_charge_dollar": 83489, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 113884, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 128840, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 80819, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 113884, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 101602, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 113884, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "other", "standard_charge_algorithm": "May include reimbursement for certain add-on services.", "standard_charge_dollar": 83489, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 101602, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 101602, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 101602, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 113884, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH MCC", "code_information": [{"code": "326", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 81960.71, "gross_charge": 96424.36, "discounted_cash": 57854.62, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH CC", "code_information": [{"code": "327", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 52994.7, "gross_charge": 55265.24, "discounted_cash": 33159.14, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "328", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6680.0, "maximum": 25047.19, "gross_charge": 29541.28, "discounted_cash": 17724.77, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 84.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC", "code_information": [{"code": "329", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 7121.0, "maximum": 131997.54, "gross_charge": 155291.23, "discounted_cash": 93174.74, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 21996, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10650, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7121, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8589, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 60.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 21996, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8810, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8810, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7121, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8589, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7121, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8589, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8810, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH CC", "code_information": [{"code": "330", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6429.0, "maximum": 47309.76, "gross_charge": 55658.54, "discounted_cash": 33395.12, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10075, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9714, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 11896, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10461, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6429, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8124, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7197, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7392, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 11896, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10075, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9000, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 11896, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9714, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7011, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7011, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10075, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10075, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10075, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7197, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7392, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7197, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7392, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7011, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 11896, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MAJOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "331", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 48269.89, "gross_charge": 56929.1, "discounted_cash": 34157.46, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "RECTAL RESECTION WITH CC", "code_information": [{"code": "333", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 55152.16, "gross_charge": 64884.89, "discounted_cash": 38930.93, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "RECTAL RESECTION WITHOUT CC/MCC", "code_information": [{"code": "334", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 13856.72, "gross_charge": 16715.02, "discounted_cash": 10029.01, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PERITONEAL ADHESIOLYSIS WITH MCC", "code_information": [{"code": "335", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 46295.45, "gross_charge": 54487.34, "discounted_cash": 32692.4, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PERITONEAL ADHESIOLYSIS WITH CC", "code_information": [{"code": "336", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 50336.38, "gross_charge": 59219.27, "discounted_cash": 35531.56, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PERITONEAL ADHESIOLYSIS WITHOUT CC/MCC", "code_information": [{"code": "337", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 4923.82, "maximum": 35299.7, "gross_charge": 41529.06, "discounted_cash": 24917.44, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MINOR SMALL AND LARGE BOWEL PROCEDURES WITH CC", "code_information": [{"code": "345", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 55723.34, "gross_charge": 63637.86, "discounted_cash": 38182.72, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MINOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "346", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 52683.69, "gross_charge": 55806.04, "discounted_cash": 33483.62, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ANAL AND STOMAL PROCEDURES WITH MCC", "code_information": [{"code": "347", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "maximum": 41995.8, "gross_charge": 24883.3, "discounted_cash": 14929.98, "minimum": 6680, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 84.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ANAL AND STOMAL PROCEDURES WITH CC", "code_information": [{"code": "348", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 21197.88, "gross_charge": 21744.55, "discounted_cash": 13046.73, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ANAL AND STOMAL PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "349", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "maximum": 10598.94, "gross_charge": 11508.66, "discounted_cash": 6905.2, "minimum": 6680, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 84.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "INGUINAL AND FEMORAL HERNIA PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "352", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "maximum": 16632.04, "gross_charge": 19567.1, "discounted_cash": 11740.26, "minimum": 6027, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH MCC", "code_information": [{"code": "353", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 10481.0, "maximum": 419958.0, "gross_charge": 331524.29, "discounted_cash": 198914.57, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10481, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 51.1, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 59.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 60.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10481, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 59.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 59.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH CC", "code_information": [{"code": "354", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 53505.85, "gross_charge": 62873.81, "discounted_cash": 37724.29, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITHOUT CC/MCC", "code_information": [{"code": "355", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 38552.22, "gross_charge": 45362.65, "discounted_cash": 27217.59, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH MCC", "code_information": [{"code": "356", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "maximum": 215277.27, "gross_charge": 253267.38, "discounted_cash": 151960.43, "minimum": 8564, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 84.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH CC", "code_information": [{"code": "357", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 82550.76, "gross_charge": 97182.39, "discounted_cash": 58309.43, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "358", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "maximum": 42395.76, "gross_charge": 49570.0, "discounted_cash": 29742.0, "minimum": 6027, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8575, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8575, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8575, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8575, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8575, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MAJOR ESOPHAGEAL DISORDERS WITH MCC", "code_information": [{"code": "368", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "maximum": 28692.8, "gross_charge": 33756.24, "discounted_cash": 20253.74, "minimum": 7121, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 21996, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10650, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8681, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 14292, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7121, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8589, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9761, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 21996, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8810, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8810, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7121, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8589, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7121, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8589, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8810, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MAJOR ESOPHAGEAL DISORDERS WITH CC", "code_information": [{"code": "369", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 41995.8, "gross_charge": 38651.25, "discounted_cash": 23190.75, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8575, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8575, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8575, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8575, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8575, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MAJOR ESOPHAGEAL DISORDERS WITHOUT CC/MCC", "code_information": [{"code": "370", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 27471.32, "gross_charge": 32319.2, "discounted_cash": 19391.52, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH MCC", "code_information": [{"code": "371", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 210546.11, "gross_charge": 36589.55, "discounted_cash": 21953.73, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH CC", "code_information": [{"code": "372", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 31496.85, "gross_charge": 28473.6, "discounted_cash": 17084.16, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITHOUT CC/MCC", "code_information": [{"code": "373", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 31709.5, "gross_charge": 31709.5, "discounted_cash": 19025.7, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "GASTROINTESTINAL HEMORRHAGE WITH MCC", "code_information": [{"code": "377", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6485.0, "maximum": 31496.85, "gross_charge": 28309.4, "discounted_cash": 16985.64, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "GASTROINTESTINAL HEMORRHAGE WITH CC", "code_information": [{"code": "378", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 25170.92, "gross_charge": 29612.85, "discounted_cash": 17767.71, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "GASTROINTESTINAL HEMORRHAGE WITHOUT CC/MCC", "code_information": [{"code": "379", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 12291.94, "gross_charge": 14442.35, "discounted_cash": 8665.41, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "COMPLICATED PEPTIC ULCER WITH CC", "code_information": [{"code": "381", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 28821.68, "gross_charge": 24096.79, "discounted_cash": 14458.07, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "COMPLICATED PEPTIC ULCER WITHOUT CC/MCC", "code_information": [{"code": "382", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 37065.84, "gross_charge": 20177.2, "discounted_cash": 12106.32, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "UNCOMPLICATED PEPTIC ULCER WITH MCC", "code_information": [{"code": "383", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 1500.0, "maximum": 5749425.0, "gross_charge": 171238.84, "discounted_cash": 102743.3, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA BEHAVIORAL HEALTH SLC", "methodology": "per diem", "standard_charge_dollar": 1500, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem. Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem. Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 60.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "OPTUM HEALTH [259]", "plan_name": "BJC HB COMMERCIAL UBH SLC", "methodology": "per diem", "standard_charge_dollar": 1500, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "OPTUM HEALTH BEHAVIORAL HEALTH [576]", "plan_name": "BJC HB COMMERCIAL UBH SLC", "methodology": "per diem", "standard_charge_dollar": 1500, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "UNCOMPLICATED PEPTIC ULCER WITHOUT MCC", "code_information": [{"code": "384", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 44106.39, "gross_charge": 51881.06, "discounted_cash": 31128.64, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "INFLAMMATORY BOWEL DISEASE WITH MCC", "code_information": [{"code": "385", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 63971.25, "gross_charge": 75302.49, "discounted_cash": 45181.49, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "INFLAMMATORY BOWEL DISEASE WITH CC", "code_information": [{"code": "386", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 83991.6, "gross_charge": 71545.66, "discounted_cash": 42927.4, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "INFLAMMATORY BOWEL DISEASE WITHOUT CC/MCC", "code_information": [{"code": "387", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 42395.76, "gross_charge": 43619.75, "discounted_cash": 26171.85, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "GASTROINTESTINAL OBSTRUCTION WITH MCC", "code_information": [{"code": "388", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "maximum": 31433.3, "gross_charge": 36980.35, "discounted_cash": 22188.21, "minimum": 6027, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "GASTROINTESTINAL OBSTRUCTION WITH CC", "code_information": [{"code": "389", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 31496.85, "gross_charge": 30981.86, "discounted_cash": 18589.12, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "GASTROINTESTINAL OBSTRUCTION WITHOUT CC/MCC", "code_information": [{"code": "390", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 22850.0, "gross_charge": 23422.45, "discounted_cash": 14053.47, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITH MCC", "code_information": [{"code": "391", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 7121.0, "maximum": 31796.82, "gross_charge": 33741.85, "discounted_cash": 20245.11, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 20827, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 21996, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 12391, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 10650, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 8681, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 14292, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 7121, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 8589, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 12391, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 20827, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 9761, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 12391, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 21996, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 8810, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 8810, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 20827, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 20827, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 20827, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 7121, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 8589, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 7121, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 8589, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 8810, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 12391, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC", "code_information": [{"code": "392", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 21197.88, "gross_charge": 24448.1, "discounted_cash": 14668.86, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OTHER DIGESTIVE SYSTEM DIAGNOSES WITH MCC", "code_information": [{"code": "393", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 43948.74, "gross_charge": 51704.4, "discounted_cash": 31022.64, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OTHER DIGESTIVE SYSTEM DIAGNOSES WITH CC", "code_information": [{"code": "394", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 20304.67, "gross_charge": 24107.55, "discounted_cash": 14464.53, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OTHER DIGESTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC", "code_information": [{"code": "395", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 12615.6, "gross_charge": 14841.88, "discounted_cash": 8905.13, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "APPENDIX PROCEDURES WITH MCC", "code_information": [{"code": "397", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 94490.55, "gross_charge": 86308.22, "discounted_cash": 51784.93, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "APPENDIX PROCEDURES WITH CC", "code_information": [{"code": "398", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 66200.0, "gross_charge": 73515.04, "discounted_cash": 44109.02, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "APPENDIX PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "399", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 39487.25, "gross_charge": 46457.13, "discounted_cash": 27874.28, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SINGLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL", "code_information": [{"code": "402", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 9657.0, "maximum": 134827.18, "gross_charge": 158623.96, "discounted_cash": 95174.38, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 129929, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "other", "standard_charge_algorithm": "May include reimbursement for certain add-on services.", "standard_charge_dollar": 105847, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies and other services can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 118800, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 123072, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 129929, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 60.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "other", "standard_charge_algorithm": "May include reimbursement for certain add-on services.", "standard_charge_dollar": 105847, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 84934, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 89181, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 129929, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 129929, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 129929, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 118800, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 123072, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 118800, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 123072, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 84934, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PANCREAS, LIVER AND SHUNT PROCEDURES WITH MCC", "code_information": [{"code": "405", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "maximum": 501270.3, "gross_charge": 589729.76, "discounted_cash": 353837.86, "minimum": 10481, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10481, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 51.1, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 59.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 60.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10481, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 59.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 59.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH MCC", "code_information": [{"code": "408", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6680.0, "maximum": 201379.86, "gross_charge": 215334.19, "discounted_cash": 129200.51, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 51.1, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 60.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH CC", "code_information": [{"code": "409", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6680.0, "maximum": 137786.22, "gross_charge": 154081.94, "discounted_cash": 92449.16, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 60.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CHOLECYSTECTOMY WITH C.D.E. WITH MCC", "code_information": [{"code": "411", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "maximum": 67427.1, "gross_charge": 79326.0, "discounted_cash": 47595.6, "minimum": 6027, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CHOLECYSTECTOMY WITH C.D.E. WITH CC", "code_information": [{"code": "412", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "maximum": 45788.18, "gross_charge": 53868.44, "discounted_cash": 32321.06, "minimum": 6027, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH MCC", "code_information": [{"code": "417", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 50004.1, "gross_charge": 58944.05, "discounted_cash": 35366.43, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH CC", "code_information": [{"code": "418", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 36284.07, "gross_charge": 42687.13, "discounted_cash": 25612.28, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT CC/MCC", "code_information": [{"code": "419", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "maximum": 42936.76, "gross_charge": 50513.83, "discounted_cash": 30308.3, "minimum": 6027, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITH CC", "code_information": [{"code": "427", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 9657.0, "maximum": 219684.43, "gross_charge": 232965.31, "discounted_cash": 139779.19, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 129929, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "other", "standard_charge_algorithm": "May include reimbursement for certain add-on services.", "standard_charge_dollar": 192168, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional anesthesia services, supplies, and other services can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 118800, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 123072, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 129929, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 60.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "other", "standard_charge_algorithm": "May include reimbursement for certain add-on services.", "standard_charge_dollar": 192168, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 84934, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 89181, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 129929, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 129929, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 129929, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 118800, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 123072, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 118800, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 123072, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 84934, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITHOUT CC/MCC", "code_information": [{"code": "428", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6680.0, "maximum": 197153.82, "gross_charge": 231945.66, "discounted_cash": 139167.4, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 129929, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 51.1, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 129929, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 60.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 84934, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 89181, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 129929, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 129929, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 129929, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 84934, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "COMBINED ANTERIOR AND POSTERIOR CERVICAL SPINAL FUSION WITHOUT MCC", "code_information": [{"code": "430", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 9657.0, "maximum": 274155.69, "gross_charge": 322536.09, "discounted_cash": 193521.65, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 129929, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "other", "standard_charge_algorithm": "May include reimbursement for certain add-on services.", "standard_charge_dollar": 148008, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs, supplies, and other services can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 118800, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 123072, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 129929, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 60.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "other", "standard_charge_algorithm": "May include reimbursement for certain add-on services.", "standard_charge_dollar": 148008, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 84934, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 89181, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 129929, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 129929, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 129929, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 118800, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 123072, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 118800, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 123072, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 84934, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC", "code_information": [{"code": "433", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "maximum": 19161.63, "gross_charge": 22543.08, "discounted_cash": 13525.85, "minimum": 6027, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH MCC", "code_information": [{"code": "435", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 25554.57, "gross_charge": 60348.4, "discounted_cash": 36209.04, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH CC", "code_information": [{"code": "436", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "maximum": 21197.88, "gross_charge": 24369.15, "discounted_cash": 14621.49, "minimum": 6027, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITHOUT CC/MCC", "code_information": [{"code": "437", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 5736.35, "maximum": 10598.94, "gross_charge": 12061.5, "discounted_cash": 7236.9, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH MCC", "code_information": [{"code": "438", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 63593.64, "gross_charge": 72430.55, "discounted_cash": 43458.33, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC", "code_information": [{"code": "439", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 7689.0, "maximum": 42027.8, "gross_charge": 42027.8, "discounted_cash": 25216.68, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 84.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT CC/MCC", "code_information": [{"code": "440", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 21197.88, "gross_charge": 22058.8, "discounted_cash": 13235.28, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH MCC", "code_information": [{"code": "441", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 74192.58, "gross_charge": 87165.45, "discounted_cash": 52299.27, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH CC", "code_information": [{"code": "442", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 41848.94, "gross_charge": 49234.8, "discounted_cash": 29540.88, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITHOUT CC/MCC", "code_information": [{"code": "443", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 23212.48, "gross_charge": 27309.25, "discounted_cash": 16385.55, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DISORDERS OF THE BILIARY TRACT WITH MCC", "code_information": [{"code": "444", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 32260.98, "gross_charge": 37946.6, "discounted_cash": 22767.96, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DISORDERS OF THE BILIARY TRACT WITH CC", "code_information": [{"code": "445", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "maximum": 38085.69, "gross_charge": 44947.7, "discounted_cash": 26968.62, "minimum": 6027, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DISORDERS OF THE BILIARY TRACT WITHOUT CC/MCC", "code_information": [{"code": "446", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6485.0, "maximum": 31496.85, "gross_charge": 27449.15, "discounted_cash": 16469.49, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MULTIPLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC", "code_information": [{"code": "448", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 9657.0, "maximum": 147085.37, "gross_charge": 173256.75, "discounted_cash": 103954.05, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 145217, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "other", "standard_charge_algorithm": "May include reimbursement for certain add-on services.", "standard_charge_dollar": 110482, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional anesthesia services, supplies, and other services can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 91442, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 94500, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 145217, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 60.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "other", "standard_charge_algorithm": "May include reimbursement for certain add-on services.", "standard_charge_dollar": 110482, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 84934, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 89181, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 145217, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 145217, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 145217, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 91442, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 94500, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 91442, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 94500, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 84934, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SINGLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC", "code_information": [{"code": "451", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 145217.0, "gross_charge": 110220.02, "discounted_cash": 66132.01, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 145217, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "other", "standard_charge_algorithm": "May include reimbursement for certain add-on services.", "standard_charge_dollar": 83494, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional anesthesia services, supplies, and other services can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 64083, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 65928, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 145217, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "other", "standard_charge_algorithm": "May include reimbursement for certain add-on services.", "standard_charge_dollar": 83494, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 84934, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 89181, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 145217, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 145217, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 145217, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 64083, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 65928, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 64083, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 65928, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 84934, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH MCC", "code_information": [{"code": "456", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 29997.0, "maximum": 203963.35, "gross_charge": 240257.09, "discounted_cash": 144154.25, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 187049, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "other", "standard_charge_algorithm": "May include reimbursement for certain add-on services.", "standard_charge_dollar": 145281, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 60874, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 65207, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 43317, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 82783, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 92126, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 60874, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 187049, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 52750, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 60874, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "other", "standard_charge_algorithm": "May include reimbursement for certain add-on services.", "standard_charge_dollar": 145281, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 52953, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 52953, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 187049, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 187049, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 187049, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 82783, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 92126, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 82783, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 92126, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 52953, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 60874, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH CC", "code_information": [{"code": "457", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 43317.0, "maximum": 187049.0, "gross_charge": 207929.23, "discounted_cash": 124757.54, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 187049, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "other", "standard_charge_algorithm": "May include reimbursement for certain add-on services.", "standard_charge_dollar": 145281, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 60874, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 65207, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 43317, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 82783, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 92126, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 60874, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 187049, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 52750, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 60874, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "other", "standard_charge_algorithm": "May include reimbursement for certain add-on services.", "standard_charge_dollar": 145281, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 52953, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 52953, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 187049, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 187049, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 187049, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 82783, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 92126, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 82783, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 92126, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 52953, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 60874, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITHOUT CC/MCC", "code_information": [{"code": "458", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 29997.0, "maximum": 187049.0, "gross_charge": 154610.73, "discounted_cash": 92766.44, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 187049, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "other", "standard_charge_algorithm": "May include reimbursement for certain add-on services.", "standard_charge_dollar": 145281, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 60874, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 65207, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 43317, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 82783, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 92126, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 60874, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 187049, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 52750, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 60874, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "other", "standard_charge_algorithm": "May include reimbursement for certain add-on services.", "standard_charge_dollar": 145281, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 52953, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 52953, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 187049, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 187049, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 187049, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 82783, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 92126, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 82783, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 92126, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 52953, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 60874, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH MCC", "code_information": [{"code": "463", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6485.0, "maximum": 107267.0, "gross_charge": 81035.97, "discounted_cash": 48621.58, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 107267, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 80247, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 89970, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 70212, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 83740, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 91409, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 80247, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 107267, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 75736, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 80247, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 74174, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 74174, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 107267, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 107267, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 107267, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 83740, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 91409, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 83740, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 91409, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 74174, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 80247, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH CC", "code_information": [{"code": "464", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 139668.97, "gross_charge": 164316.44, "discounted_cash": 98589.86, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 107267, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 107267, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 60.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 74174, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 74174, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 107267, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 107267, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 107267, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 74174, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC", "code_information": [{"code": "465", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "maximum": 107267.0, "gross_charge": 32937.7, "discounted_cash": 19762.62, "minimum": 9221, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 107267, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 80247, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 89970, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 70212, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 84.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 83740, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 91409, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 80247, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 107267, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 75736, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 80247, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 74174, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 74174, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 107267, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 107267, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 107267, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 83740, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 91409, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 83740, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 91409, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 74174, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 80247, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CERVICAL SPINAL FUSION WITH CC", "code_information": [{"code": "472", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 29997.0, "maximum": 128611.0, "gross_charge": 152346.61, "discounted_cash": 91407.97, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 127936, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "other", "standard_charge_algorithm": "May include reimbursement for certain add-on services.", "standard_charge_dollar": 104023, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 65106, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 63276, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 46181, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 58011, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 128611, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 65106, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 127936, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 52467, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 65106, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "other", "standard_charge_algorithm": "May include reimbursement for certain add-on services.", "standard_charge_dollar": 104023, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 51385, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 51385, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 127936, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 127936, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 127936, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 58011, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 128611, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 58011, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 128611, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 51385, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 65106, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CERVICAL SPINAL FUSION WITHOUT CC/MCC", "code_information": [{"code": "473", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "maximum": 128611.0, "gross_charge": 88394.2, "discounted_cash": 53036.52, "minimum": 6027, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs, supplies, and other services can be included in reimbursement.", "standard_charge_dollar": 127936, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "other", "standard_charge_algorithm": "May include reimbursement for certain add-on services.", "standard_charge_dollar": 104023, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs, supplies, and other services can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs, supplies, and other services can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs, supplies, and other services can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 58011, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 128611, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs, supplies, and other services can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs, supplies, and other services can be included in reimbursement.", "standard_charge_dollar": 127936, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs, supplies, and other services can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "other", "standard_charge_algorithm": "May include reimbursement for certain add-on services.", "standard_charge_dollar": 104023, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 51385, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 51385, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs, supplies, and other services can be included in reimbursement.", "standard_charge_dollar": 127936, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs, supplies, and other services can be included in reimbursement.", "standard_charge_dollar": 127936, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs, supplies, and other services can be included in reimbursement.", "standard_charge_dollar": 127936, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 58011, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 128611, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 58011, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 128611, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 51385, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs, supplies, and other services can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH CC", "code_information": [{"code": "475", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "maximum": 240500.69, "gross_charge": 283082.99, "discounted_cash": 169849.79, "minimum": 9221, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 51.1, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 59.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 60.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 59.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 59.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC", "code_information": [{"code": "477", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 80672.98, "gross_charge": 94909.38, "discounted_cash": 56945.63, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC", "code_information": [{"code": "478", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 47952.75, "gross_charge": 56415.0, "discounted_cash": 33849.0, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC", "code_information": [{"code": "479", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 43668.66, "gross_charge": 51374.89, "discounted_cash": 30824.93, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH MCC", "code_information": [{"code": "480", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6485.0, "maximum": 62879.4, "gross_charge": 73975.75, "discounted_cash": 44385.45, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 58953, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "other", "standard_charge_algorithm": "May include reimbursement for certain add-on services.", "standard_charge_dollar": 40182, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 34363, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 23666, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 16358, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 21382, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 26188, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 34363, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 58953, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 19622, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 34363, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "other", "standard_charge_algorithm": "May include reimbursement for certain add-on services.", "standard_charge_dollar": 40182, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 19217, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 19217, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 58953, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 58953, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 58953, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 21382, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 26188, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 21382, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 26188, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 19217, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 34363, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH CC", "code_information": [{"code": "481", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6485.0, "maximum": 60955.03, "gross_charge": 71711.81, "discounted_cash": 43027.09, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 58953, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "other", "standard_charge_algorithm": "May include reimbursement for certain add-on services.", "standard_charge_dollar": 40182, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 34363, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 23666, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 16358, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 21382, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 26188, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 34363, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 58953, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 19622, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 34363, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "other", "standard_charge_algorithm": "May include reimbursement for certain add-on services.", "standard_charge_dollar": 40182, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 19217, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 19217, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 58953, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 58953, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 58953, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 21382, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 26188, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 21382, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 26188, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 19217, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 34363, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT CC/MCC", "code_information": [{"code": "482", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6485.0, "maximum": 58953.0, "gross_charge": 53838.53, "discounted_cash": 32303.12, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 58953, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "other", "standard_charge_algorithm": "May include reimbursement for certain add-on services.", "standard_charge_dollar": 40182, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 34363, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 23666, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 16358, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 21382, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 26188, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 34363, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 58953, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 19622, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 34363, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "other", "standard_charge_algorithm": "May include reimbursement for certain add-on services.", "standard_charge_dollar": 40182, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 19217, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 19217, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 58953, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 58953, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 58953, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 21382, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 26188, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 21382, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 26188, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 19217, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 34363, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MAJOR JOINT OR LIMB REATTACHMENT PROCEDURES OF UPPER EXTREMITIES", "code_information": [{"code": "483", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 19998.0, "maximum": 122791.35, "gross_charge": 145857.4, "discounted_cash": 87514.44, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 80067, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "other", "standard_charge_algorithm": "May include reimbursement for certain add-on services.", "standard_charge_dollar": 66416, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 53585, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 52078, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 38009, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 47748, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 51868, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 53585, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 80067, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 43183, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 53585, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "other", "standard_charge_algorithm": "May include reimbursement for certain add-on services.", "standard_charge_dollar": 66416, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 42292, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 42292, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 80067, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 80067, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 80067, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 47748, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 51868, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 47748, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 51868, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 42292, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 53585, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH CC", "code_information": [{"code": "486", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 29787.01, "gross_charge": 35043.53, "discounted_cash": 21026.12, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC", "code_information": [{"code": "487", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 25140.1, "gross_charge": 29576.58, "discounted_cash": 17745.95, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITH CC/MCC", "code_information": [{"code": "488", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 50022.78, "gross_charge": 58845.22, "discounted_cash": 35307.13, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC", "code_information": [{"code": "489", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "maximum": 45497.02, "gross_charge": 53525.9, "discounted_cash": 32115.54, "minimum": 6027, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH MCC", "code_information": [{"code": "492", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 7660.0, "maximum": 58476.82, "gross_charge": 68796.25, "discounted_cash": 41277.75, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 43980, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "other", "standard_charge_algorithm": "May include reimbursement for certain add-on services.", "standard_charge_dollar": 34478, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 35922, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 38403, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 25370, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7660, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 34700, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 34421, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 35922, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 43980, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 31843, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 35922, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "other", "standard_charge_algorithm": "May include reimbursement for certain add-on services.", "standard_charge_dollar": 34478, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 31185, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 31185, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 43980, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 43980, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 43980, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 34700, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 34421, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 34700, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 34421, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 31185, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 35922, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH CC", "code_information": [{"code": "493", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6485.0, "maximum": 57264.63, "gross_charge": 67370.14, "discounted_cash": 40422.08, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 43980, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "other", "standard_charge_algorithm": "May include reimbursement for certain add-on services.", "standard_charge_dollar": 34478, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 35922, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 38403, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 25370, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 34700, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 34421, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 35922, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 43980, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 31843, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 35922, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "other", "standard_charge_algorithm": "May include reimbursement for certain add-on services.", "standard_charge_dollar": 34478, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 31185, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 31185, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 43980, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 43980, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 43980, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 34700, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 34421, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 34700, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 34421, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 31185, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 35922, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITHOUT CC/MCC", "code_information": [{"code": "494", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6485.0, "maximum": 43980.0, "gross_charge": 37321.02, "discounted_cash": 22392.61, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 43980, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "other", "standard_charge_algorithm": "May include reimbursement for certain add-on services.", "standard_charge_dollar": 34478, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 35922, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 38403, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 25370, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 34700, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 34421, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 35922, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 43980, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 31843, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 35922, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "other", "standard_charge_algorithm": "May include reimbursement for certain add-on services.", "standard_charge_dollar": 34478, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 31185, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 31185, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 43980, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 43980, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 43980, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 34700, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 34421, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 34700, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 34421, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 31185, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 35922, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH MCC", "code_information": [{"code": "495", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "maximum": 303280.09, "gross_charge": 356800.1, "discounted_cash": 214080.06, "minimum": 10481, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10481, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 52405, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 58690, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 43484, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 53568, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 59627, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 52405, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 49403, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 52405, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10481, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 48383, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 48383, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 53568, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 59627, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 53568, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 59627, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 48383, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 52405, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH CC", "code_information": [{"code": "496", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 63315.11, "gross_charge": 74488.37, "discounted_cash": 44693.02, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs, supplies, and other services can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 48383, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 48383, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 48383, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITHOUT CC/MCC", "code_information": [{"code": "497", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "maximum": 59627.0, "gross_charge": 59048.27, "discounted_cash": 35428.96, "minimum": 6485, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 52405, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 58690, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 43484, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 53568, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 59627, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 52405, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 49403, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 52405, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 48383, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 48383, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 53568, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 59627, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 53568, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 59627, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 48383, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 52405, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITH CC/MCC", "code_information": [{"code": "498", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 36399.35, "gross_charge": 42823.21, "discounted_cash": 25693.93, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SOFT TISSUE PROCEDURES WITH MCC", "code_information": [{"code": "500", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 123008.09, "gross_charge": 74787.23, "discounted_cash": 44872.34, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 52940, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 52940, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 52940, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 52940, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 52940, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SOFT TISSUE PROCEDURES WITH CC", "code_information": [{"code": "501", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 52940.0, "gross_charge": 25355.05, "discounted_cash": 15213.03, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_dollar": 52940, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_dollar": 52940, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_dollar": 52940, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_dollar": 52940, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_dollar": 52940, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SOFT TISSUE PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "502", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 52940.0, "gross_charge": 33340.25, "discounted_cash": 20004.15, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 52940, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 52940, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 52940, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 52940, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 52940, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MAJOR THUMB OR JOINT PROCEDURES", "code_information": [{"code": "506", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "maximum": 10498.95, "gross_charge": 6350.3, "discounted_cash": 3810.18, "minimum": 6027, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH CC", "code_information": [{"code": "511", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 8564.0, "maximum": 111149.37, "gross_charge": 131071.31, "discounted_cash": 78642.79, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies and other services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies and other services can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 31943, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 31043, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 22657, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 28462, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 30919, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 31943, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies and other services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 25741, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 31943, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies and other services can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional services can be included in reimbursement.", "standard_charge_dollar": 25210, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional services can be included in reimbursement.", "standard_charge_dollar": 25210, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies and other services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies and other services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies and other services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 28462, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 30919, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 28462, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 30919, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional services can be included in reimbursement.", "standard_charge_dollar": 25210, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 31943, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "512", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6485.0, "maximum": 33898.39, "gross_charge": 39880.45, "discounted_cash": 23928.27, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 31943, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 31043, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 22657, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 28462, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 30919, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 31943, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 25741, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 31943, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 25210, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 25210, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 28462, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 30919, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 28462, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 30919, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 25210, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 31943, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITH CC/MCC", "code_information": [{"code": "513", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 44018.4, "gross_charge": 51798.3, "discounted_cash": 31078.98, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 20827, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 21996, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 14292, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 20827, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 21996, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 20827, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 20827, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 20827, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "514", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 48672.94, "gross_charge": 57262.28, "discounted_cash": 34357.37, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH MCC", "code_information": [{"code": "515", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 9221.0, "maximum": 165686.74, "gross_charge": 202900.68, "discounted_cash": 121740.41, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 48085, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 34064, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 38175, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 29682, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 38416, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 42759, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 34064, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 48085, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 35428, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 34064, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 34698, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 34698, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 48085, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 48085, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 48085, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 38416, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 42759, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 38416, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 42759, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 34698, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 34064, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH CC", "code_information": [{"code": "516", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 9221.0, "maximum": 105653.65, "gross_charge": 124298.41, "discounted_cash": 74579.05, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 48085, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 34064, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 38175, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 29682, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 38416, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 42759, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 34064, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 48085, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 35428, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 34064, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 34698, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 34698, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 48085, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 48085, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 48085, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 38416, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 42759, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 38416, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 42759, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 34698, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 34064, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "517", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6485.0, "maximum": 48085.0, "gross_charge": 48978.41, "discounted_cash": 29387.05, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 48085, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 34064, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 38175, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 29682, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 38416, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 42759, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 34064, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 48085, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 35428, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 34064, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 34698, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 34698, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 48085, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 48085, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 48085, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 38416, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 42759, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 38416, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 42759, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 34698, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 34064, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH MCC OR DISC DEVICE OR NEUROSTIMULATOR", "code_information": [{"code": "518", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 9221.0, "maximum": 116448.47, "gross_charge": 136998.2, "discounted_cash": 82198.92, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 99502, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 49208, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 47824, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 34906, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 84.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 43210, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 59538, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 49208, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 99502, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 39655, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 49208, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 38837, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 38837, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 99502, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 99502, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 99502, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 43210, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 59538, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 43210, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 59538, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 38837, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 49208, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH CC", "code_information": [{"code": "519", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 9221.0, "maximum": 99502.0, "gross_charge": 83671.7, "discounted_cash": 50203.02, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 99502, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 49208, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 47824, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 34906, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 84.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 43210, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 59538, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 49208, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 99502, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 39655, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 49208, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 38837, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 38837, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 99502, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 99502, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 99502, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 43210, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 59538, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 43210, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 59538, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 38837, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 49208, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITHOUT CC/MCC", "code_information": [{"code": "520", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6485.0, "maximum": 99502.0, "gross_charge": 94049.23, "discounted_cash": 56429.54, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 99502, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "other", "standard_charge_algorithm": "May include reimbursement for certain add-on services.", "standard_charge_dollar": 59357, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 49208, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 47824, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 34906, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 43210, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 59538, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 49208, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 99502, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 39655, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 49208, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "other", "standard_charge_algorithm": "May include reimbursement for certain add-on services.", "standard_charge_dollar": 59357, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 38837, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 38837, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 99502, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 99502, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 99502, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 43210, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 59538, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 43210, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 59538, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 38837, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 49208, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FRACTURES OF FEMUR WITH MCC", "code_information": [{"code": "533", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "maximum": 31496.85, "gross_charge": 24137.45, "discounted_cash": 14482.47, "minimum": 6027, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FRACTURES OF FEMUR WITHOUT MCC", "code_information": [{"code": "534", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 20545.44, "gross_charge": 24173.4, "discounted_cash": 14504.04, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FRACTURES OF HIP AND PELVIS WITHOUT MCC", "code_information": [{"code": "536", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6429.0, "maximum": 20997.9, "gross_charge": 20100.6, "discounted_cash": 12060.36, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 10075, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9714, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 11896, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 10461, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6429, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 8124, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 7197, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7392, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 11896, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 10075, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 9000, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 11896, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9714, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7011, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7011, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 10075, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 10075, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 10075, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 7197, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7392, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 7197, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7392, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7011, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 11896, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OSTEOMYELITIS WITH MCC", "code_information": [{"code": "539", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 49188.91, "gross_charge": 57874.9, "discounted_cash": 34724.94, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OSTEOMYELITIS WITH CC", "code_information": [{"code": "540", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 31496.85, "gross_charge": 30133.16, "discounted_cash": 18079.9, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OSTEOMYELITIS WITHOUT CC/MCC", "code_information": [{"code": "541", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 14200.06, "gross_charge": 16705.95, "discounted_cash": 10023.57, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and radiology services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and radiology services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and radiology services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and radiology services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and radiology services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and radiology services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and radiology services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and radiology services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and radiology services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and radiology services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and radiology services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and radiology services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and radiology services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and radiology services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and radiology services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and radiology services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and radiology services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and radiology services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and radiology services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and radiology services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and radiology services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and radiology services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and radiology services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and radiology services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and radiology services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH MCC", "code_information": [{"code": "542", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "maximum": 621565.65, "gross_charge": 731803.7, "discounted_cash": 439082.22, "minimum": 10481, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10481, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 51.1, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 59.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 60.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10481, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 59.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 59.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH CC", "code_information": [{"code": "543", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "maximum": 51785.0, "gross_charge": 14857.15, "discounted_cash": 8914.29, "minimum": 6027, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 51785, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 51785, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 51785, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 51785, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 51785, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITHOUT CC/MCC", "code_information": [{"code": "544", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "maximum": 76892.19, "gross_charge": 26549.32, "discounted_cash": 15929.59, "minimum": 6027, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 51785, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 51785, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 51785, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 51785, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 51785, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CONNECTIVE TISSUE DISORDERS WITH MCC", "code_information": [{"code": "545", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 52994.7, "gross_charge": 58762.4, "discounted_cash": 35257.44, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CONNECTIVE TISSUE DISORDERS WITH CC", "code_information": [{"code": "546", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 62993.7, "gross_charge": 62355.3, "discounted_cash": 37413.18, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC", "code_information": [{"code": "547", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 37641.4, "gross_charge": 44529.15, "discounted_cash": 26717.49, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SEPTIC ARTHRITIS WITH CC", "code_information": [{"code": "549", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 57784.46, "gross_charge": 67981.71, "discounted_cash": 40789.03, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SEPTIC ARTHRITIS WITHOUT CC/MCC", "code_information": [{"code": "550", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 43075.01, "gross_charge": 50682.53, "discounted_cash": 30409.52, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MEDICAL BACK PROBLEMS WITHOUT MCC", "code_information": [{"code": "552", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 32804.0, "gross_charge": 31859.25, "discounted_cash": 19115.55, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_dollar": 32804, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_dollar": 32804, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_dollar": 32804, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_dollar": 32804, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_dollar": 32804, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "BONE DISEASES AND ARTHROPATHIES WITHOUT MCC", "code_information": [{"code": "554", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 58053.45, "gross_charge": 40914.09, "discounted_cash": 24548.45, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC", "code_information": [{"code": "555", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "maximum": 132787.86, "gross_charge": 156221.0, "discounted_cash": 93732.6, "minimum": 6027, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 21996, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 21996, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT MCC", "code_information": [{"code": "556", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 22710.85, "gross_charge": 26718.65, "discounted_cash": 16031.19, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TENDONITIS, MYOSITIS AND BURSITIS WITH MCC", "code_information": [{"code": "557", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 8564.0, "maximum": 243775.62, "gross_charge": 263608.35, "discounted_cash": 158165.01, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 51.1, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 59.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 60.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 59.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 59.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TENDONITIS, MYOSITIS AND BURSITIS WITHOUT MCC", "code_information": [{"code": "558", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6370.0, "maximum": 31496.85, "gross_charge": 25473.8, "discounted_cash": 15284.28, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 11276, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9888, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9956, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6370, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7660, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6844, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8804, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9888, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 11276, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8500, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9888, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8267, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8267, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 11276, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 11276, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 11276, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6844, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8804, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6844, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8804, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8267, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9888, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC", "code_information": [{"code": "559", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "maximum": 52994.7, "gross_charge": 54793.75, "discounted_cash": 32876.25, "minimum": 6027, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC", "code_information": [{"code": "560", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 95390.46, "gross_charge": 101063.44, "discounted_cash": 60638.06, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITH MCC", "code_information": [{"code": "562", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 31832.03, "gross_charge": 37449.75, "discounted_cash": 22469.85, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITHOUT MCC", "code_information": [{"code": "563", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "maximum": 45609.9, "gross_charge": 25979.4, "discounted_cash": 15587.64, "minimum": 6027, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH MCC", "code_information": [{"code": "564", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 38856.0, "gross_charge": 27314.55, "discounted_cash": 16388.73, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH CC", "code_information": [{"code": "565", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 78553.43, "gross_charge": 92415.8, "discounted_cash": 55449.48, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITHOUT CC/MCC", "code_information": [{"code": "566", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 27631.72, "gross_charge": 32648.9, "discounted_cash": 19589.34, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SKIN DEBRIDEMENT WITH CC", "code_information": [{"code": "571", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 41506.63, "gross_charge": 48831.33, "discounted_cash": 29298.8, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SKIN DEBRIDEMENT WITHOUT CC/MCC", "code_information": [{"code": "572", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 21299.32, "gross_charge": 25029.17, "discounted_cash": 15017.5, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC", "code_information": [{"code": "578", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "maximum": 28682.86, "gross_charge": 33833.79, "discounted_cash": 20300.27, "minimum": 6027, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH CC", "code_information": [{"code": "580", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "maximum": 30383.41, "gross_charge": 19739.1, "discounted_cash": 11843.46, "minimum": 6027, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "581", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 33392.3, "gross_charge": 39287.3, "discounted_cash": 23572.38, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MAJOR SKIN DISORDERS WITH MCC", "code_information": [{"code": "595", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 12330.02, "gross_charge": 14505.9, "discounted_cash": 8703.54, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MAJOR SKIN DISORDERS WITHOUT MCC", "code_information": [{"code": "596", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 5391.11, "maximum": 20997.9, "gross_charge": 19946.9, "discounted_cash": 11968.14, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CELLULITIS WITH MCC", "code_information": [{"code": "602", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 4871.0, "maximum": 15364.0, "gross_charge": 10043.3, "discounted_cash": 6025.98, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CELLULITIS WITHOUT MCC", "code_information": [{"code": "603", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 18216.01, "gross_charge": 21430.75, "discounted_cash": 12858.45, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITH MCC", "code_information": [{"code": "604", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 1500.0, "maximum": 1819818.0, "gross_charge": 92580.25, "discounted_cash": 55548.15, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA BEHAVIORAL HEALTH SLC", "methodology": "per diem", "standard_charge_dollar": 1500, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem. Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem. Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "OPTUM HEALTH [259]", "plan_name": "BJC HB COMMERCIAL UBH SLC", "methodology": "per diem", "standard_charge_dollar": 1500, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "OPTUM HEALTH BEHAVIORAL HEALTH [576]", "plan_name": "BJC HB COMMERCIAL UBH SLC", "methodology": "per diem", "standard_charge_dollar": 1500, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITHOUT MCC", "code_information": [{"code": "605", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 21307.75, "gross_charge": 25067.94, "discounted_cash": 15040.76, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MINOR SKIN DISORDERS WITH MCC", "code_information": [{"code": "606", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 43672.02, "gross_charge": 51378.85, "discounted_cash": 30827.31, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MINOR SKIN DISORDERS WITHOUT MCC", "code_information": [{"code": "607", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 31496.85, "gross_charge": 26723.95, "discounted_cash": 16034.37, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ADRENAL AND PITUITARY PROCEDURES WITH CC/MCC", "code_information": [{"code": "614", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 7121.0, "maximum": 125535.84, "gross_charge": 151368.22, "discounted_cash": 90820.93, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 21996, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 10650, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7121, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8589, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9761, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 21996, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8810, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8810, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7121, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8589, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7121, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8589, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8810, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ADRENAL AND PITUITARY PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "615", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 36315.99, "gross_charge": 42724.69, "discounted_cash": 25634.81, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "627", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "maximum": 32362.34, "gross_charge": 38073.35, "discounted_cash": 22844.01, "minimum": 6027, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH MCC", "code_information": [{"code": "628", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "maximum": 66118.23, "gross_charge": 77774.55, "discounted_cash": 46664.73, "minimum": 6027, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH CC", "code_information": [{"code": "629", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6680.0, "maximum": 142972.54, "gross_charge": 168124.09, "discounted_cash": 100874.45, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 79.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 60.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "630", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 71042.36, "gross_charge": 25152.6, "discounted_cash": 15091.56, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DIABETES WITH MCC", "code_information": [{"code": "637", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 41995.8, "gross_charge": 38747.15, "discounted_cash": 23248.29, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 21996, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 21996, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DIABETES WITH CC", "code_information": [{"code": "638", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6485.0, "maximum": 21996.0, "gross_charge": 22813.45, "discounted_cash": 13688.07, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 21996, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 12391, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 10650, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 8681, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 12391, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 9761, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 12391, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 21996, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 8810, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 8810, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 8810, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 12391, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DIABETES WITHOUT CC/MCC", "code_information": [{"code": "639", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 23845.54, "gross_charge": 22326.0, "discounted_cash": 13395.6, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITH MCC", "code_information": [{"code": "640", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 52494.75, "gross_charge": 36745.0, "discounted_cash": 22047.0, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITHOUT MCC", "code_information": [{"code": "641", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 31496.85, "gross_charge": 21571.0, "discounted_cash": 12942.6, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "INBORN AND OTHER DISORDERS OF METABOLISM", "code_information": [{"code": "642", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 45214.19, "gross_charge": 53199.11, "discounted_cash": 31919.47, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional radiology services can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional radiology services can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ENDOCRINE DISORDERS WITH MCC", "code_information": [{"code": "643", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 7121.0, "maximum": 32032.59, "gross_charge": 37685.4, "discounted_cash": 22611.24, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 21996, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10650, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8681, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 14292, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7121, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8589, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9761, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 21996, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8810, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8810, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7121, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8589, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7121, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8589, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8810, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ENDOCRINE DISORDERS WITH CC", "code_information": [{"code": "644", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 7121.0, "maximum": 23046.0, "gross_charge": 25071.85, "discounted_cash": 15043.11, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 20827, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 21996, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 12391, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 10650, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 8681, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 14292, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 7121, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 8589, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 12391, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 20827, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 9761, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 12391, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 21996, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 8810, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 8810, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 20827, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 20827, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 20827, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 7121, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 8589, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 7121, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 8589, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 8810, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 12391, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ENDOCRINE DISORDERS WITHOUT CC/MCC", "code_information": [{"code": "645", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "maximum": 11918.06, "gross_charge": 14021.25, "discounted_cash": 8412.75, "minimum": 6027, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "KIDNEY TRANSPLANT WITH HEMODIALYSIS WITH MCC", "code_information": [{"code": "650", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 10481.0, "maximum": 651207.03, "gross_charge": 651207.03, "discounted_cash": 390724.22, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 10481, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 51.1, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 59.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 60.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 10481, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 59.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 59.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MAJOR BLADDER PROCEDURES WITH MCC", "code_information": [{"code": "653", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 66506.27, "gross_charge": 78242.67, "discounted_cash": 46945.6, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MAJOR BLADDER PROCEDURES WITH CC", "code_information": [{"code": "654", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 74942.9, "gross_charge": 88173.97, "discounted_cash": 52904.38, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH CC", "code_information": [{"code": "657", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 91969.82, "gross_charge": 108199.79, "discounted_cash": 64919.87, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITHOUT CC/MCC", "code_information": [{"code": "658", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6370.0, "maximum": 76623.16, "gross_charge": 90583.64, "discounted_cash": 54350.18, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 11276, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 9888, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9956, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6370, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 7660, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6844, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 8804, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 9888, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 11276, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 8500, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 9888, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 8267, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 8267, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 11276, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 11276, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 11276, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6844, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 8804, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6844, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 8804, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 8267, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 9888, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH MCC", "code_information": [{"code": "659", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 83496.97, "gross_charge": 98231.73, "discounted_cash": 58939.04, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH CC", "code_information": [{"code": "660", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 58388.94, "gross_charge": 68692.85, "discounted_cash": 41215.71, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITHOUT CC/MCC", "code_information": [{"code": "661", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 59533.38, "gross_charge": 70039.26, "discounted_cash": 42023.56, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MINOR BLADDER PROCEDURES WITH CC", "code_information": [{"code": "663", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6370.0, "maximum": 60539.76, "gross_charge": 71223.24, "discounted_cash": 42733.94, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 11276, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9888, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9956, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6370, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7660, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6844, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8804, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9888, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 11276, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8500, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9888, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8267, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8267, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 11276, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 11276, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 11276, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6844, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8804, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6844, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8804, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8267, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9888, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "URETHRAL PROCEDURES WITH CC/MCC", "code_information": [{"code": "671", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "maximum": 105989.4, "gross_charge": 115836.48, "discounted_cash": 69501.89, "minimum": 6429, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 10075, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9714, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 11896, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 10461, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6429, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 7197, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7392, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 11896, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 10075, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 9000, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 11896, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9714, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7011, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7011, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 10075, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 10075, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 10075, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 7197, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7392, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 7197, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7392, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7011, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 11896, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "URETHRAL PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "672", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 31796.82, "gross_charge": 36381.01, "discounted_cash": 21828.61, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH MCC", "code_information": [{"code": "673", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6370.0, "maximum": 91653.88, "gross_charge": 107829.34, "discounted_cash": 64697.6, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 11276, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 9888, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 9956, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 6370, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 7660, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6844, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 8804, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 9888, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 11276, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 8500, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 9888, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 8267, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 8267, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 11276, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 11276, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 11276, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6844, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 8804, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6844, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 8804, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 8267, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 9888, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH CC", "code_information": [{"code": "674", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6680.0, "maximum": 170562.89, "gross_charge": 200615.47, "discounted_cash": 120369.28, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 20827, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 21996, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 51.1, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 20827, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 60.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 21996, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 20827, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 20827, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 20827, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "RENAL FAILURE WITH MCC", "code_information": [{"code": "682", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 63593.64, "gross_charge": 69730.5, "discounted_cash": 41838.3, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "RENAL FAILURE WITH CC", "code_information": [{"code": "683", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 31796.82, "gross_charge": 32670.6, "discounted_cash": 19602.36, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 20827, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 21996, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 14292, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 20827, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 21996, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 20827, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 20827, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 20827, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "RENAL FAILURE WITHOUT CC/MCC", "code_information": [{"code": "684", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 20997.9, "gross_charge": 23780.5, "discounted_cash": 14268.3, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "KIDNEY AND URINARY TRACT NEOPLASMS WITH MCC", "code_information": [{"code": "686", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "maximum": 10498.95, "gross_charge": 6568.0, "discounted_cash": 3940.8, "minimum": 6027, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional radiology services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional radiology services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional radiology services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional radiology services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional radiology services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional radiology services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional radiology services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional radiology services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional radiology services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional radiology services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional radiology services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional radiology services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional radiology services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional radiology services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional radiology services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional radiology services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional radiology services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional radiology services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional radiology services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional radiology services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional radiology services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional radiology services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional radiology services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional radiology services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional radiology services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional radiology services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional radiology services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional radiology services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "KIDNEY AND URINARY TRACT NEOPLASMS WITHOUT CC/MCC", "code_information": [{"code": "688", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 52494.75, "gross_charge": 51807.45, "discounted_cash": 31084.47, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "KIDNEY AND URINARY TRACT INFECTIONS WITH MCC", "code_information": [{"code": "689", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 41995.8, "gross_charge": 37671.58, "discounted_cash": 22602.95, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "KIDNEY AND URINARY TRACT INFECTIONS WITHOUT MCC", "code_information": [{"code": "690", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 20997.9, "gross_charge": 20622.8, "discounted_cash": 12373.68, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "URINARY STONES WITH MCC", "code_information": [{"code": "693", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 43112.98, "gross_charge": 50721.15, "discounted_cash": 30432.69, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "URINARY STONES WITHOUT MCC", "code_information": [{"code": "694", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 52994.7, "gross_charge": 53026.4, "discounted_cash": 31815.84, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITHOUT MCC", "code_information": [{"code": "696", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 4851.45, "maximum": 10598.94, "gross_charge": 11373.0, "discounted_cash": 6823.8, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH MCC", "code_information": [{"code": "698", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6485.0, "maximum": 88044.95, "gross_charge": 63061.04, "discounted_cash": 37836.62, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH CC", "code_information": [{"code": "699", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 34648.81, "gross_charge": 40763.3, "discounted_cash": 24457.98, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITHOUT CC/MCC", "code_information": [{"code": "700", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 20997.9, "gross_charge": 17653.95, "discounted_cash": 10592.37, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TESTES PROCEDURES WITH CC/MCC", "code_information": [{"code": "711", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 35047.14, "gross_charge": 41231.93, "discounted_cash": 24739.16, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TESTES PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "712", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 26246.89, "gross_charge": 30878.7, "discounted_cash": 18527.22, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT MCC", "code_information": [{"code": "728", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "maximum": 20997.9, "gross_charge": 14305.8, "discounted_cash": 8583.48, "minimum": 6027, "payers_information": [{"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITH CC/MCC", "code_information": [{"code": "742", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 44121.5, "gross_charge": 52159.44, "discounted_cash": 31295.66, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC", "code_information": [{"code": "743", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 23173.51, "gross_charge": 27266.6, "discounted_cash": 16359.96, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITH CC/MCC", "code_information": [{"code": "744", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6680.0, "maximum": 142058.95, "gross_charge": 167145.58, "discounted_cash": 100287.35, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 60.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITHOUT CC/MCC", "code_information": [{"code": "745", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 36224.4, "gross_charge": 42626.14, "discounted_cash": 25575.68, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "VAGINA, CERVIX AND VULVA PROCEDURES WITH CC/MCC", "code_information": [{"code": "746", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "maximum": 699930.0, "gross_charge": 58158.95, "discounted_cash": 34895.37, "minimum": 1500, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 2130, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "case rate", "standard_charge_dollar": 1860, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA BEHAVIORAL HEALTH SLC", "methodology": "per diem", "standard_charge_dollar": 1500, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 2861, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 2404, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 2579, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem. Additional drugs, labs, and other services can be included in reimbursement.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem. Additional drugs, labs, and other services can be included in reimbursement.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 2130, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "case rate", "standard_charge_dollar": 1860, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "OPTUM HEALTH [259]", "plan_name": "BJC HB COMMERCIAL UBH SLC", "methodology": "per diem", "standard_charge_dollar": 1500, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_percentage": 54.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_percentage": 54.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 2130, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 2130, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 2130, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 2404, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 2579, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "OPTUM HEALTH BEHAVIORAL HEALTH [576]", "plan_name": "BJC HB COMMERCIAL UBH SLC", "methodology": "per diem", "standard_charge_dollar": 1500, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 2404, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 2579, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_percentage": 54.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "VAGINA, CERVIX AND VULVA PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "747", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "maximum": 40995.59, "gross_charge": 48230.09, "discounted_cash": 28938.05, "minimum": 6027, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES", "code_information": [{"code": "748", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6370.0, "maximum": 50646.72, "gross_charge": 59588.72, "discounted_cash": 35753.23, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 11276, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 9888, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 9956, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 6370, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 7660, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6844, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 8804, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 9888, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 11276, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 8500, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 9888, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 8267, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 8267, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 11276, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 11276, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 11276, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6844, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 8804, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6844, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 8804, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 8267, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 9888, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH CC", "code_information": [{"code": "758", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "maximum": 52494.75, "gross_charge": 32418.2, "discounted_cash": 19450.92, "minimum": 6027, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC", "code_information": [{"code": "759", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "maximum": 10498.95, "gross_charge": 7201.45, "discounted_cash": 4320.87, "minimum": 6027, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITH CC/MCC", "code_information": [{"code": "760", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 7121.0, "maximum": 32983.1, "gross_charge": 38804.05, "discounted_cash": 23282.43, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 20827, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 21996, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 12391, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 10650, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 8681, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 14292, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 7121, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 8589, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 12391, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 20827, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 9761, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 12391, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 21996, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 8810, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 8810, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 20827, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 20827, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 20827, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 7121, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 8589, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 7121, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 8589, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 8810, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 12391, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT CC/MCC", "code_information": [{"code": "761", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 15549.95, "gross_charge": 18294.05, "discounted_cash": 10976.43, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY", "code_information": [{"code": "789", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 7011.0, "maximum": 125791.33, "gross_charge": 147989.8, "discounted_cash": 88793.88, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10075, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9714, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 11896, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10461, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7197, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7392, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 11896, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10075, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9000, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 11896, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9714, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7011, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7011, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10075, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10075, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10075, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7197, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7392, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7197, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7392, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7011, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 11896, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE", "code_information": [{"code": "790", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 2080.0, "maximum": 388461.15, "gross_charge": 223491.6, "discounted_cash": 134094.96, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6994, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 2840, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 51.1, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 2080, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 2134, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6994, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 60.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 2840, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6994, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6994, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6994, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 2080, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 2134, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 2080, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 2134, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PREMATURITY WITH MAJOR PROBLEMS", "code_information": [{"code": "791", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 1558.0, "maximum": 199480.05, "gross_charge": 107606.0, "discounted_cash": 64563.6, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 2468, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 2840, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 2345, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 2281, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 1558, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 1859, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 2080, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 2134, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 2345, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 2468, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 1800, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 2345, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 2840, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 1730, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 1730, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 2468, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 2468, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 2468, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 2080, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 2134, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 2080, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 2134, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 1730, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 2345, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PREMATURITY WITHOUT MAJOR PROBLEMS", "code_information": [{"code": "792", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 1558.0, "maximum": 146985.3, "gross_charge": 79268.15, "discounted_cash": 47560.89, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 2468, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy 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"standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 2281, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 1558, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 5801, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 2080, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 2134, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7873, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 2468, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 1800, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7873, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 2840, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 1730, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 1730, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 2468, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 2468, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 2468, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 2080, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 2134, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 2080, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 2134, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 1730, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7873, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FULL TERM NEONATE WITH MAJOR PROBLEMS", "code_information": [{"code": "793", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 3496.0, "maximum": 87917.72, "gross_charge": 48733.5, "discounted_cash": 29240.1, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6994, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 5676, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7873, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6387, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 3496, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 5801, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 3768, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 3869, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7873, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6994, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 3775, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7873, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 5676, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 3532, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 3532, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6994, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6994, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6994, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 3768, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 3869, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 3768, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 3869, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 3532, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7873, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "NEONATE WITH OTHER SIGNIFICANT PROBLEMS", "code_information": [{"code": "794", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 21029.85, "gross_charge": 21029.85, "discounted_cash": 12617.91, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "NORMAL NEWBORN", "code_information": [{"code": "795", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 3342.06, "maximum": 10498.95, "gross_charge": 6890.85, "discounted_cash": 4134.51, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SPLENIC PROCEDURES WITH MCC", "code_information": [{"code": "799", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 95641.11, "gross_charge": 112596.09, "discounted_cash": 67557.65, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies and other services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies and other services can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies and other services can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies and other services can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies and other services can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies and other services can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies and other services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies and other services can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies and other services can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies and other services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies and other services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies and other services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional supplies and other services can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SPLENIC PROCEDURES WITH CC", "code_information": [{"code": "800", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6370.0, "maximum": 49326.52, "gross_charge": 58031.2, "discounted_cash": 34818.72, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 11276, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9888, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9956, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6370, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7660, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6844, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8804, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9888, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 11276, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8500, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9888, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8267, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8267, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 11276, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 11276, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 11276, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6844, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8804, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6844, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8804, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8267, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9888, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SPLENIC PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "801", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 25221.69, "gross_charge": 29672.57, "discounted_cash": 17803.54, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH CC", "code_information": [{"code": "803", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 85911.13, "gross_charge": 101071.91, "discounted_cash": 60643.15, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITHOUT CC/MCC", "code_information": [{"code": "804", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "maximum": 37419.97, "gross_charge": 44023.49, "discounted_cash": 26414.09, "minimum": 6027, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH MCC", "code_information": [{"code": "808", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 7121.0, "maximum": 58829.73, "gross_charge": 69211.45, "discounted_cash": 41526.87, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 52075, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 21996, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10650, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8681, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 14292, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7121, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8589, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 52075, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9761, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 21996, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8810, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8810, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 52075, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 52075, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 52075, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7121, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8589, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7121, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8589, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8810, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH CC", "code_information": [{"code": "809", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 52075.0, "gross_charge": 28576.95, "discounted_cash": 17146.17, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 52075, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 52075, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 52075, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 52075, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 52075, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITHOUT CC/MCC", "code_information": [{"code": "810", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 52075.0, "gross_charge": 20493.05, "discounted_cash": 12295.83, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 52075, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 52075, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 52075, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 52075, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 52075, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "RED BLOOD CELL DISORDERS WITH MCC", "code_information": [{"code": "811", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 41368.86, "gross_charge": 48856.45, "discounted_cash": 29313.87, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 20827, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 21996, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 14292, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 18786, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 21266, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 20827, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 21996, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 20827, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 20827, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 20827, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 18786, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 21266, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 18786, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 21266, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "RED BLOOD CELL DISORDERS WITHOUT MCC", "code_information": [{"code": "812", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 41995.8, "gross_charge": 30975.11, "discounted_cash": 18585.07, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 17786, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 21266, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 17786, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 21266, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 17786, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 21266, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "COAGULATION DISORDERS", "code_information": [{"code": "813", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 31496.85, "gross_charge": 31138.85, "discounted_cash": 18683.31, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH MCC", "code_information": [{"code": "814", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 7121.0, "maximum": 66571.0, "gross_charge": 41454.25, "discounted_cash": 24872.55, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 21996, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 10650, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 8681, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 14292, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 7121, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 8589, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 9761, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 21996, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 8810, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 8810, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 7121, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 8589, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 7121, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 8589, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 8810, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH CC", "code_information": [{"code": "815", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 34943.59, "gross_charge": 41110.1, "discounted_cash": 24666.06, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITHOUT CC/MCC", "code_information": [{"code": "816", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 22469.03, "gross_charge": 26434.15, "discounted_cash": 15860.49, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH MCC", "code_information": [{"code": "820", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6680.0, "maximum": 375712.46, "gross_charge": 442014.64, "discounted_cash": 265208.78, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and radiology services can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 51.1, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 60.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and radiology services can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH MCC", "code_information": [{"code": "823", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "maximum": 294953.26, "gross_charge": 144699.03, "discounted_cash": 86819.42, "minimum": 6680, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and radiology services can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and radiology services can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH CC", "code_information": [{"code": "824", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 104989.5, "gross_charge": 101924.45, "discounted_cash": 61154.67, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "825", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 28657.33, "gross_charge": 33714.5, "discounted_cash": 20228.7, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITH CC/MCC", "code_information": [{"code": "829", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 63593.64, "gross_charge": 67759.08, "discounted_cash": 40655.45, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "830", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 71636.23, "gross_charge": 84277.91, "discounted_cash": 50566.75, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ACUTE LEUKEMIA WITH MCC", "code_information": [{"code": "834", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 10481.0, "maximum": 404993.43, "gross_charge": 476462.85, "discounted_cash": 285877.71, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10481, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 51.1, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 59.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 60.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10481, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 59.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 59.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ACUTE LEUKEMIA WITH CC", "code_information": [{"code": "835", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 45664.69, "gross_charge": 53723.16, "discounted_cash": 32233.9, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS OR WITH HIGH DOSE CHEMOTHERAPY AGENT WITH MCC", "code_information": [{"code": "837", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6680.0, "maximum": 220477.95, "gross_charge": 172931.3, "discounted_cash": 103758.78, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 60.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC OR HIGH DOSE CHEMOTHERAPY AGENT", "code_information": [{"code": "838", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 45259.93, "gross_charge": 51133.6, "discounted_cash": 30680.16, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC", "code_information": [{"code": "839", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 23929.11, "gross_charge": 28151.89, "discounted_cash": 16891.13, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and therapy services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and therapy services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and therapy services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and therapy services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and therapy services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LYMPHOMA AND NON-ACUTE LEUKEMIA WITH MCC", "code_information": [{"code": "840", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6680.0, "maximum": 180181.98, "gross_charge": 191283.62, "discounted_cash": 114770.17, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 92690, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 51.1, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 92690, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 60.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 92690, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 92690, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 92690, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LYMPHOMA AND NON-ACUTE LEUKEMIA WITHOUT CC/MCC", "code_information": [{"code": "842", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 92690.0, "gross_charge": 39436.45, "discounted_cash": 23661.87, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 92690, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 92690, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 92690, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 92690, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 92690, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH CC", "code_information": [{"code": "844", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 70366.35, "gross_charge": 25685.0, "discounted_cash": 15411.0, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITHOUT CC/MCC", "code_information": [{"code": "845", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "maximum": 25490.83, "gross_charge": 29989.2, "discounted_cash": 17993.52, "minimum": 6027, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH MCC", "code_information": [{"code": "846", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 55456.0, "gross_charge": 22582.05, "discounted_cash": 13549.23, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 55456, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 55456, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 55456, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 55456, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 55456, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC", "code_information": [{"code": "847", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 55456.0, "gross_charge": 25279.75, "discounted_cash": 15167.85, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 55456, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 55456, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 55456, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 55456, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 55456, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC", "code_information": [{"code": "848", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "maximum": 55456.0, "gross_charge": 40294.55, "discounted_cash": 24176.73, "minimum": 6027, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 55456, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 55456, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 55456, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 55456, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 55456, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "RADIOTHERAPY", "code_information": [{"code": "849", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "maximum": 62039.58, "gross_charge": 82716.99, "discounted_cash": 49630.19, "minimum": 6027, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ACUTE LEUKEMIA WITH OTHER PROCEDURES", "code_information": [{"code": "850", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 10481.0, "maximum": 363490.54, "gross_charge": 427635.93, "discounted_cash": 256581.56, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 10481, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 51.1, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 59.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 60.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 10481, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 59.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 59.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH MCC", "code_information": [{"code": "853", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 21996.0, "maximum": 251217.09, "gross_charge": 295549.52, "discounted_cash": 177329.71, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 21996, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 51.1, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 59.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 60.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 21996, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 59.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 59.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH CC", "code_information": [{"code": "854", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 103007.98, "gross_charge": 121185.85, "discounted_cash": 72711.51, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH MCC", "code_information": [{"code": "856", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 29737.97, "gross_charge": 34985.85, "discounted_cash": 20991.51, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH CC", "code_information": [{"code": "857", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 55484.48, "gross_charge": 65275.85, "discounted_cash": 39165.51, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITH MCC", "code_information": [{"code": "862", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 83991.6, "gross_charge": 68341.1, "discounted_cash": 41004.66, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITHOUT MCC", "code_information": [{"code": "863", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 21197.88, "gross_charge": 22096.6, "discounted_cash": 13257.96, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FEVER AND INFLAMMATORY CONDITIONS", "code_information": [{"code": "864", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 20997.9, "gross_charge": 20715.75, "discounted_cash": 12429.45, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "VIRAL ILLNESS WITH MCC", "code_information": [{"code": "865", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 52994.7, "gross_charge": 59894.8, "discounted_cash": 35936.88, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "VIRAL ILLNESS WITHOUT MCC", "code_information": [{"code": "866", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 19723.49, "gross_charge": 23204.1, "discounted_cash": 13922.46, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH MCC", "code_information": [{"code": "867", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "maximum": 41995.8, "gross_charge": 37171.7, "discounted_cash": 22303.02, "minimum": 6027, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 21996, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 21996, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH CC", "code_information": [{"code": "868", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 7121.0, "maximum": 21996.0, "gross_charge": 23300.45, "discounted_cash": 13980.27, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 20827, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 21996, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 12391, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 10650, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 8681, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 14292, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 7121, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 8589, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 12391, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 20827, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 9761, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 12391, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 21996, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 8810, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 8810, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 20827, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 20827, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 20827, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 7121, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 8589, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 7121, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 8589, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 8810, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 12391, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITHOUT CC/MCC", "code_information": [{"code": "869", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "maximum": 23487.35, "gross_charge": 26095.1, "discounted_cash": 15657.06, "minimum": 6027, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS", "code_information": [{"code": "870", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 10481.0, "maximum": 262210.59, "gross_charge": 308819.04, "discounted_cash": 185291.42, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10481, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 51.1, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 59.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 60.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10481, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 59.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 59.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC", "code_information": [{"code": "871", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 7121.0, "maximum": 82359.57, "gross_charge": 72047.75, "discounted_cash": 43228.65, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 21996, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10650, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8681, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 14292, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7121, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8589, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9761, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 21996, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8810, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8810, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7121, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8589, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7121, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8589, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8810, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC", "code_information": [{"code": "872", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 7689.0, "maximum": 31742.4, "gross_charge": 31729.7, "discounted_cash": 19037.82, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 84.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "O.R. PROCEDURES WITH PRINCIPAL DIAGNOSIS OF MENTAL ILLNESS", "code_information": [{"code": "876", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 536917.57, "gross_charge": 54870.26, "discounted_cash": 32922.16, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION", "code_information": [{"code": "880", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 31496.85, "gross_charge": 30308.05, "discounted_cash": 18184.83, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DEPRESSIVE NEUROSES", "code_information": [{"code": "881", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 1500.0, "maximum": 399960.0, "gross_charge": 36384.3, "discounted_cash": 21830.58, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 2130, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "case rate", "standard_charge_dollar": 1860, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 51.7, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA BEHAVIORAL HEALTH SLC", "methodology": "per diem", "standard_charge_dollar": 1500, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 2861, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 2404, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 2579, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem. Additional drugs, labs, and other services can be included in reimbursement.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem. Additional drugs, labs, and other services can be included in reimbursement.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 2130, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 70.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "case rate", "standard_charge_dollar": 1860, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "OPTUM HEALTH [259]", "plan_name": "BJC HB COMMERCIAL UBH SLC", "methodology": "per diem", "standard_charge_dollar": 1500, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_percentage": 54.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_percentage": 54.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 2130, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 2130, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 2130, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 2404, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 2579, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "OPTUM HEALTH BEHAVIORAL HEALTH [576]", "plan_name": "BJC HB COMMERCIAL UBH SLC", "methodology": "per diem", "standard_charge_dollar": 1500, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 2404, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 2579, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_percentage": 54.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "NEUROSES EXCEPT DEPRESSIVE", "code_information": [{"code": "882", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 1500.0, "maximum": 559944.0, "gross_charge": 48511.35, "discounted_cash": 29106.81, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 2130, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "case rate", "standard_charge_dollar": 1860, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA BEHAVIORAL HEALTH SLC", "methodology": "per diem", "standard_charge_dollar": 1500, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 2861, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 2404, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 2579, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem. Additional drugs, labs, and other services can be included in reimbursement.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem. Additional drugs, labs, and other services can be included in reimbursement.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 2130, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "case rate", "standard_charge_dollar": 1860, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "OPTUM HEALTH [259]", "plan_name": "BJC HB COMMERCIAL UBH SLC", "methodology": "per diem", "standard_charge_dollar": 1500, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_percentage": 54.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_percentage": 54.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 2130, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 2130, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 2130, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 2404, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 2579, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "OPTUM HEALTH BEHAVIORAL HEALTH [576]", "plan_name": "BJC HB COMMERCIAL UBH SLC", "methodology": "per diem", "standard_charge_dollar": 1500, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 2404, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 2579, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_percentage": 54.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DISORDERS OF PERSONALITY AND IMPULSE CONTROL", "code_information": [{"code": "883", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 73492.65, "gross_charge": 45285.0, "discounted_cash": 27171.0, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional labs and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ORGANIC DISTURBANCES AND INTELLECTUAL DISABILITY", "code_information": [{"code": "884", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 1500.0, "maximum": 79992.0, "gross_charge": 24004.65, "discounted_cash": 14402.79, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 2130, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA BEHAVIORAL HEALTH SLC", "methodology": "per diem", "standard_charge_dollar": 1500, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 2861, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 2404, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 2579, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem. Additional drugs can be included in reimbursement.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem. Additional drugs can be included in reimbursement.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 2130, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "OPTUM HEALTH [259]", "plan_name": "BJC HB COMMERCIAL UBH SLC", "methodology": "per diem", "standard_charge_dollar": 1500, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 2130, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 2130, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 2130, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 2404, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 2579, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "OPTUM HEALTH BEHAVIORAL HEALTH [576]", "plan_name": "BJC HB COMMERCIAL UBH SLC", "methodology": "per diem", "standard_charge_dollar": 1500, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 2404, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 2579, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PSYCHOSES", "code_information": [{"code": "885", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 1500.0, "maximum": 559944.0, "gross_charge": 44550.63, "discounted_cash": 26730.38, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 2130, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA BEHAVIORAL HEALTH SLC", "methodology": "per diem", "standard_charge_dollar": 1500, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 2861, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 2404, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 2579, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and therapy services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem. Additional drugs, labs, supplies, and therapy services can be included in reimbursement.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem. Additional drugs, labs, supplies, and therapy services can be included in reimbursement.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and therapy services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 2130, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and therapy services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "OPTUM HEALTH [259]", "plan_name": "BJC HB COMMERCIAL UBH SLC", "methodology": "per diem", "standard_charge_dollar": 1500, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 2130, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 2130, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 2130, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and therapy services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 2404, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 2579, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "OPTUM HEALTH BEHAVIORAL HEALTH [576]", "plan_name": "BJC HB COMMERCIAL UBH SLC", "methodology": "per diem", "standard_charge_dollar": 1500, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 2404, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 2579, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and therapy services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, supplies, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "BEHAVIORAL AND DEVELOPMENTAL DISORDERS", "code_information": [{"code": "886", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 1500.0, "maximum": 629937.0, "gross_charge": 43977.75, "discounted_cash": 26386.65, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 2130, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA BEHAVIORAL HEALTH SLC", "methodology": "per diem", "standard_charge_dollar": 1500, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 2861, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 2404, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 2579, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem. Additional drugs, labs, and therapy services can be included in reimbursement.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem. Additional drugs, labs, and therapy services can be included in reimbursement.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 2130, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "OPTUM HEALTH [259]", "plan_name": "BJC HB COMMERCIAL UBH SLC", "methodology": "per diem", "standard_charge_dollar": 1500, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 2130, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 2130, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 2130, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 2404, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 2579, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "OPTUM HEALTH BEHAVIORAL HEALTH [576]", "plan_name": "BJC HB COMMERCIAL UBH SLC", "methodology": "per diem", "standard_charge_dollar": 1500, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 2404, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 2579, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OTHER MENTAL DISORDER DIAGNOSES", "code_information": [{"code": "887", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 62993.7, "gross_charge": 36931.35, "discounted_cash": 22158.81, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC", "code_information": [{"code": "896", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 20997.9, "gross_charge": 18632.45, "discounted_cash": 11179.47, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC", "code_information": [{"code": "897", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 1500.0, "maximum": 359964.0, "gross_charge": 36895.45, "discounted_cash": 22137.27, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA BEHAVIORAL HEALTH SLC", "methodology": "per diem", "standard_charge_dollar": 1500, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem. Additional drugs, labs, and other services can be included in reimbursement.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem. Additional drugs, labs, and other services can be included in reimbursement.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "OPTUM HEALTH [259]", "plan_name": "BJC HB COMMERCIAL UBH SLC", "methodology": "per diem", "standard_charge_dollar": 1500, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "OPTUM HEALTH BEHAVIORAL HEALTH [576]", "plan_name": "BJC HB COMMERCIAL UBH SLC", "methodology": "per diem", "standard_charge_dollar": 1500, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "WOUND DEBRIDEMENTS FOR INJURIES WITH CC", "code_information": [{"code": "902", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 64945.13, "gross_charge": 76258.83, "discounted_cash": 45755.3, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "WOUND DEBRIDEMENTS FOR INJURIES WITHOUT CC/MCC", "code_information": [{"code": "903", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 45166.57, "gross_charge": 53192.88, "discounted_cash": 31915.73, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SKIN GRAFTS FOR INJURIES WITH CC/MCC", "code_information": [{"code": "904", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "maximum": 190780.92, "gross_charge": 219815.31, "discounted_cash": 131889.19, "minimum": 6680, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 51.1, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 60.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HAND PROCEDURES FOR INJURIES", "code_information": [{"code": "906", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 203080.73, "gross_charge": 156804.96, "discounted_cash": 94082.98, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 21996, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 60.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 21996, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OTHER O.R. PROCEDURES FOR INJURIES WITH MCC", "code_information": [{"code": "907", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 65987.35, "gross_charge": 77632.17, "discounted_cash": 46579.3, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OTHER O.R. PROCEDURES FOR INJURIES WITH CC", "code_information": [{"code": "908", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 62993.7, "gross_charge": 54708.65, "discounted_cash": 32825.19, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OTHER O.R. PROCEDURES FOR INJURIES WITHOUT CC/MCC", "code_information": [{"code": "909", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "maximum": 17649.74, "gross_charge": 20764.4, "discounted_cash": 12458.64, "minimum": 6027, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TRAUMATIC INJURY WITH MCC", "code_information": [{"code": "913", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "maximum": 46443.88, "gross_charge": 54639.85, "discounted_cash": 32783.91, "minimum": 6027, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TRAUMATIC INJURY WITHOUT MCC", "code_information": [{"code": "914", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 26964.63, "gross_charge": 31723.1, "discounted_cash": 19033.86, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ALLERGIC REACTIONS WITH MCC", "code_information": [{"code": "915", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "maximum": 21996.0, "gross_charge": 15538.15, "discounted_cash": 9322.89, "minimum": 7121, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 21996, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10650, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8681, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 14292, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7121, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8589, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9761, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 21996, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8810, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8810, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7121, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8589, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7121, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8589, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8810, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ALLERGIC REACTIONS WITHOUT MCC", "code_information": [{"code": "916", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 7121.0, "maximum": 21996.0, "gross_charge": 24105.05, "discounted_cash": 14463.03, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 21996, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10650, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8681, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 14292, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7121, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8589, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9761, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 21996, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8810, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8810, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7121, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8589, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7121, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8589, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8810, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "POISONING AND TOXIC EFFECTS OF DRUGS WITH MCC", "code_information": [{"code": "917", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 41995.8, "gross_charge": 27439.65, "discounted_cash": 16463.79, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "POISONING AND TOXIC EFFECTS OF DRUGS WITHOUT MCC", "code_information": [{"code": "918", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 1500.0, "maximum": 269973.0, "gross_charge": 25990.9, "discounted_cash": 15594.54, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 2130, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "case rate", "standard_charge_dollar": 1860, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA BEHAVIORAL HEALTH SLC", "methodology": "per diem", "standard_charge_dollar": 1500, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 2861, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 2404, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 2579, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem. Additional drugs, labs, and other services can be included in reimbursement.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem. Additional drugs, labs, and other services can be included in reimbursement.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 2130, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "case rate", "standard_charge_dollar": 1860, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "OPTUM HEALTH [259]", "plan_name": "BJC HB COMMERCIAL UBH SLC", "methodology": "per diem", "standard_charge_dollar": 1500, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_percentage": 54.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_percentage": 54.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 2130, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 2130, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 2130, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 2404, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 2579, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "OPTUM HEALTH BEHAVIORAL HEALTH [576]", "plan_name": "BJC HB COMMERCIAL UBH SLC", "methodology": "per diem", "standard_charge_dollar": 1500, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 2404, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 2579, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_percentage": 54.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "COMPLICATIONS OF TREATMENT WITH MCC", "code_information": [{"code": "919", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 31496.85, "gross_charge": 23384.0, "discounted_cash": 14030.4, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "COMPLICATIONS OF TREATMENT WITH CC", "code_information": [{"code": "920", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 16084.42, "gross_charge": 18922.85, "discounted_cash": 11353.71, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "COMPLICATIONS OF TREATMENT WITHOUT CC/MCC", "code_information": [{"code": "921", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 5063.17, "maximum": 10498.95, "gross_charge": 10439.5, "discounted_cash": 6263.7, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITH MCC", "code_information": [{"code": "922", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 42395.76, "gross_charge": 43932.15, "discounted_cash": 26359.29, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITHOUT MCC", "code_information": [{"code": "923", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "maximum": 20094.0, "gross_charge": 23640.0, "discounted_cash": 14184.0, "minimum": 6027, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional imaging services, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITH CC/MCC", "code_information": [{"code": "928", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "maximum": 26983.6, "gross_charge": 31745.4, "discounted_cash": 19047.24, "minimum": 7121, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 21996, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10650, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8681, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 14292, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7121, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8589, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9761, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 21996, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8810, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8810, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7121, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8589, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7121, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8589, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8810, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITHOUT SKIN GRAFT", "code_information": [{"code": "933", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "maximum": 24378.89, "gross_charge": 28681.05, "discounted_cash": 17208.63, "minimum": 7121, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 21996, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10650, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8681, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 14292, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7121, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8589, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9761, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 21996, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8810, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8810, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7121, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8589, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7121, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8589, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8810, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 12391, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHALATION INJURY", "code_information": [{"code": "934", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 26367.12, "gross_charge": 31020.14, "discounted_cash": 18612.08, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "NON-EXTENSIVE BURNS", "code_information": [{"code": "935", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 4429.59, "maximum": 14956.19, "gross_charge": 17595.5, "discounted_cash": 10557.3, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH CC", "code_information": [{"code": "940", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 85911.13, "gross_charge": 101071.91, "discounted_cash": 60643.15, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITHOUT CC/MCC", "code_information": [{"code": "941", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 64524.73, "gross_charge": 75914.99, "discounted_cash": 45548.99, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SIGNS AND SYMPTOMS WITH MCC", "code_information": [{"code": "947", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "maximum": 19022.82, "gross_charge": 22379.78, "discounted_cash": 13427.87, "minimum": 6027, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SIGNS AND SYMPTOMS WITHOUT MCC", "code_information": [{"code": "948", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 20516.15, "gross_charge": 24136.65, "discounted_cash": 14481.99, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "AFTERCARE WITH CC/MCC", "code_information": [{"code": "949", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "maximum": 14685.92, "gross_charge": 17277.55, "discounted_cash": 10366.53, "minimum": 6027, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "AFTERCARE WITHOUT CC/MCC", "code_information": [{"code": "950", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 13953.01, "gross_charge": 16415.3, "discounted_cash": 9849.18, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OTHER FACTORS INFLUENCING HEALTH STATUS", "code_information": [{"code": "951", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 20997.9, "gross_charge": 13703.55, "discounted_cash": 8222.13, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, imaging services, and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA", "code_information": [{"code": "955", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "maximum": 807255.26, "gross_charge": 729601.55, "discounted_cash": 437760.93, "minimum": 10481, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs, supplies, and other services can be included in reimbursement.", "standard_charge_dollar": 10481, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 51.1, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 59.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 60.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs, supplies, and other services can be included in reimbursement.", "standard_charge_dollar": 10481, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 72.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 59.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 59.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LIMB REATTACHMENT, HIP AND FEMUR PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA", "code_information": [{"code": "956", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 158989.0, "gross_charge": 140192.11, "discounted_cash": 84115.27, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs, supplies, and other services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs, supplies, and other services can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs, supplies, and other services can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs, supplies, and other services can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs, supplies, and other services can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs, supplies, and other services can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs, supplies, and other services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs, supplies, and other services can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs, supplies, and other services can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs, supplies, and other services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs, supplies, and other services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs, supplies, and other services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs, supplies, and other services can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH MCC", "code_information": [{"code": "957", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 20827.0, "maximum": 205513.18, "gross_charge": 241780.21, "discounted_cash": 145068.13, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 21996, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 67378, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 75543, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 55974, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 68952, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 75640, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 67378, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 63591, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 67378, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 21996, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 62279, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 62279, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 68952, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 75640, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 68952, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 75640, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 62279, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 67378, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH CC", "code_information": [{"code": "958", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "maximum": 124711.9, "gross_charge": 146719.87, "discounted_cash": 88031.92, "minimum": 20827, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 21996, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 67378, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 75543, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 55974, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 68952, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 75640, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 67378, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 63591, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 67378, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 21996, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 62279, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 62279, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 68952, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 75640, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 68952, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 75640, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 62279, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 67378, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC", "code_information": [{"code": "959", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6485.0, "maximum": 75640.0, "gross_charge": 34682.9, "discounted_cash": 20809.74, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 67378, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 75543, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 55974, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 68952, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 75640, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 67378, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 63591, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 67378, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional services can be included in reimbursement.", "standard_charge_dollar": 62279, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional services can be included in reimbursement.", "standard_charge_dollar": 62279, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 68952, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 75640, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 68952, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 75640, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional services can be included in reimbursement.", "standard_charge_dollar": 62279, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 67378, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OTHER MULTIPLE SIGNIFICANT TRAUMA WITH MCC", "code_information": [{"code": "963", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 48487.28, "gross_charge": 57184.85, "discounted_cash": 34310.91, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 21996, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 21996, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OTHER MULTIPLE SIGNIFICANT TRAUMA WITH CC", "code_information": [{"code": "964", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 77143.09, "gross_charge": 90756.62, "discounted_cash": 54453.97, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OTHER MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC", "code_information": [{"code": "965", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 41995.8, "gross_charge": 29788.35, "discounted_cash": 17873.01, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HIV WITH MAJOR RELATED CONDITION WITH MCC", "code_information": [{"code": "974", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "maximum": 136486.35, "gross_charge": 129404.03, "discounted_cash": 77642.42, "minimum": 6680, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC", "code_information": [{"code": "981", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 20827.0, "maximum": 217058.6, "gross_charge": 255363.06, "discounted_cash": 153217.84, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 21996, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 41063, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 46040, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 34112, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 42023, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 46098, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 41063, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 38755, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 41063, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 21996, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 37956, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 37956, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 20827, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 42023, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 46098, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 42023, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 46098, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 37956, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 41063, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC", "code_information": [{"code": "982", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 58254.29, "gross_charge": 68534.44, "discounted_cash": 41120.66, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs, supplies, and other services can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 37956, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 37956, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 37956, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, imaging services, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC", "code_information": [{"code": "983", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6485.0, "maximum": 52994.7, "gross_charge": 56298.42, "discounted_cash": 33779.05, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 41063, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 46040, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 34112, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 42023, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 46098, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 41063, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 38755, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 41063, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 37956, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 37956, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 42023, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 46098, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 42023, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 46098, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 37956, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "other", "standard_charge_algorithm": "Includes reimbursement for any outliers. May include reimbursement for certain add-on services.", "standard_charge_dollar": 41063, "count": "0", "additional_payer_notes": " Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC", "code_information": [{"code": "987", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6680.0, "maximum": 136486.35, "gross_charge": 131517.86, "discounted_cash": 78910.72, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 79.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC", "code_information": [{"code": "988", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 70799.07, "gross_charge": 83273.02, "discounted_cash": 49963.81, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC", "code_information": [{"code": "989", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 19603.81, "gross_charge": 23062.1, "discounted_cash": 13837.26, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_dollar": 9657, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_dollar": 6027, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_dollar": 6485, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_dollar": 7300, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_dollar": 9221, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_dollar": 8564, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 6680, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 7682, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_dollar": 7689, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_dollar": 10114, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "UNGROUPABLE", "code_information": [{"code": "999", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "minimum": 6027.0, "maximum": 34857.1, "gross_charge": 41008.35, "discounted_cash": 24605.01, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9657, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6027, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6485, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7300, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 9221, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 8564, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 6680, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7682, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 7689, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 10114, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "per diem", "standard_charge_algorithm": "Additional services priced at per diem.", "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HC Nursery Nb Level II", "code_information": [{"code": "172", "type": "RC"}], "standard_charges": [{"setting": "inpatient", "gross_charge": 4625, "discounted_cash": 2775}]},
 {"description": "HC Nursery Nb Level III", "code_information": [{"code": "173", "type": "RC"}], "standard_charges": [{"setting": "inpatient", "gross_charge": 6400, "discounted_cash": 3840}]},
 {"description": "HC Nursery Nb Level IV", "code_information": [{"code": "174", "type": "RC"}], "standard_charges": [{"setting": "inpatient", "gross_charge": 8925, "discounted_cash": 5355}]},
 {"description": "HC Room Icu Intermediate", "code_information": [{"code": "206", "type": "RC"}], "standard_charges": [{"setting": "inpatient", "gross_charge": 7850, "discounted_cash": 4710}]},
 {"description": "HC Room Icu Pediatric", "code_information": [{"code": "203", "type": "RC"}], "standard_charges": [{"setting": "inpatient", "gross_charge": 13075, "discounted_cash": 7845}]},
 {"description": "HC Room Semiprivate", "code_information": [{"code": "120", "type": "RC"}], "standard_charges": [{"setting": "inpatient", "gross_charge": 6000, "discounted_cash": 3600}]},
 {"description": "HC Room Icu Level V", "code_information": [{"code": "209", "type": "RC"}], "standard_charges": [{"setting": "inpatient", "gross_charge": 14375, "discounted_cash": 8625}]},
 {"description": "HC Room Semiprivate Tele", "code_information": [{"code": "120", "type": "RC"}], "standard_charges": [{"setting": "inpatient", "gross_charge": 7500, "discounted_cash": 4500}]},
 {"description": "HC Room-Intermediate Care", "code_information": [{"code": "129", "type": "RC"}], "standard_charges": [{"setting": "inpatient", "gross_charge": 6600, "discounted_cash": 3960}]},
 {"description": "HC Room Icu Transplant", "code_information": [{"code": "203", "type": "RC"}], "standard_charges": [{"setting": "inpatient", "gross_charge": 13075, "discounted_cash": 7845}]},
 {"description": "HC Room-Intermediate Care Tele", "code_information": [{"code": "129", "type": "RC"}], "standard_charges": [{"setting": "inpatient", "gross_charge": 7500, "discounted_cash": 4500}]},
 {"description": "HEPATITIS B IMMUNE GLOBULIN 220 UNIT/ML (5 ML) INTRAMUSCULAR SOLUTION", "code_information": [{"code": "90371", "type": "CPT"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 689.14, "maximum": 2222.0, "gross_charge": 2777.5, "discounted_cash": 1666.5, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2208.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 689.14, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 689.14, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 689.14, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 993.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 689.14, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 689.14, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2222.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2208.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 689.14, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1610.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 689.14, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 689.14, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 689.14, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 689.14, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1610.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 689.14, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 689.14, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HEPATITIS B IMMUNE GLOBULIN 110 UNIT/0.5 ML INTRAMUSCULAR SYRINGE", "code_information": [{"code": "90371", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "minimum": 137.83, "maximum": 635.64, "gross_charge": 794.55, "discounted_cash": 476.73, "payers_information": [{"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 137.83, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 137.83, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 460.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 137.83, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 137.83, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 137.83, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 137.83, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 460.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 137.83, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 635.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 441.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 137.83, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 137.83, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 198.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 137.83, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 137.83, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 137.83, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 441.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "RABIES IMMUNE GLOBULIN (PF) 300 UNIT/ML INTRAMUSCULAR SOLUTION", "code_information": [{"code": "90375", "type": "CPT"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 559.9, "maximum": 3609.68, "gross_charge": 1912.2, "discounted_cash": 1147.32, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1401.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 1420.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1420.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 1434.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1420.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1801.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1044.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 988.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 944.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1024.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2368.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 3609.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1625.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 1625.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1051.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1579.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 559.9, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 559.9, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1044.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 1242.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1051.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 1051.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 559.9, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1401.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 956.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1443.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1242.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 927.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 559.9, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1434.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1044.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1434.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1529.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 559.9, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1529.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1801.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 559.9, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1036.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1036.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1434.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1242.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1401.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1401.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1401.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1420.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1109.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2368.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 3609.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 1625.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1579.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1434.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1443.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1625.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1443.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1242.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2368.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 3609.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1579.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1434.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 559.9, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 559.9, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1434.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1036.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1044.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 559.9, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1529.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 559.9, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 559.9, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1420.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1434.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 559.9, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1109.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1434.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "NIRSEVIMAB-ALIP 50 MG/0.5 ML INTRAMUSCULAR SYRINGE", "code_information": [{"code": "90380", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "minimum": 406.82, "maximum": 3585.37, "gross_charge": 2235.25, "discounted_cash": 1341.15, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1638.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 1660.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1660.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 1676.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1660.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2255.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1220.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1155.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1104.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1198.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2352.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 3585.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1899.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 1899.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1229.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1846.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 460.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 406.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1220.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 1654.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1553.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 1452.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1638.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1117.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1687.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1452.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1084.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1676.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1220.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1676.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1788.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1676.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1788.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2255.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 523.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1211.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1211.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1676.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1452.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1638.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1638.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1638.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1660.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1296.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2352.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 3585.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 1899.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1846.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1676.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1687.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1899.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1687.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1452.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2352.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 3585.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1846.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1676.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 523.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 523.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1676.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1211.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1220.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 523.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1788.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1660.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1676.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1296.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1676.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "NIRSEVIMAB-ALIP 100 MG/ML INTRAMUSCULAR SYRINGE", "code_information": [{"code": "90381", "type": "CPT"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 406.82, "maximum": 3585.37, "gross_charge": 2235.25, "discounted_cash": 1341.15, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1638.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 1660.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1660.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 1676.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1660.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2255.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1220.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1155.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1104.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1198.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2352.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 3585.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1899.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 1899.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1229.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1846.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 460.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 406.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1220.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 1654.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1553.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 1452.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1638.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1117.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1687.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1452.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1084.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1676.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1220.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1676.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1788.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1676.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1788.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2255.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 523.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1211.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1211.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1676.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1452.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1638.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1638.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1638.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1660.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1296.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2352.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 3585.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 1899.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1846.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1676.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1687.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1899.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1687.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1452.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2352.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 3585.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1846.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1676.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 523.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 523.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1676.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1211.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1220.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 523.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1788.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1660.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1676.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1296.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1676.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "VARICELLA-ZOSTER IMMUNE GLOB-MALTOSE 125 UNIT/1.2 ML IM SOLUTION", "code_information": [{"code": "90396", "type": "CPT"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 2363.39, "maximum": 14704.06, "gross_charge": 10058.2, "discounted_cash": 6034.92, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7372.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 7473.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7473.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 7543.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7473.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7976.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5491.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5200.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4968.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5391.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 9647.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 14704.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 8549.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 8549.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5532.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8308.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2363.39, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2363.39, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5491.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 6537.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 5984.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 5532.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2363.39, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7372.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5029.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7593.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6537.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4878.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2363.39, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7543.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5491.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7543.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8046.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2363.39, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6135.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8046.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7976.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2363.39, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5451.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5451.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 7543.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6537.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7372.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7372.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7372.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7473.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 5833.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 9647.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 14704.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 8549.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8308.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7543.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7593.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8549.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7593.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6537.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 9647.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 14704.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8308.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 7543.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2363.39, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2363.39, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7543.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5451.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5491.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2363.39, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8046.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2363.39, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2363.39, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7473.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7543.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2363.39, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 5833.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7543.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MENINGOCOCCAL B VAC,4-CMP 50 MCG-50 MCG-50 MCG-25 MCG/0.5ML IM SYRINGE", "code_information": [{"code": "90620", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "minimum": 134.05, "maximum": 1528.78, "gross_charge": 736.55, "discounted_cash": 441.93, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 539.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 547.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 547.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 552.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 547.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 961.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 402.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 380.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 363.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 394.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1003.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1528.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 626.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 626.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 405.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 608.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 151.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 134.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 402.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 545.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 511.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 478.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 539.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 368.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 556.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 478.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 357.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 552.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 402.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 552.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 589.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 552.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 589.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 961.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 172.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 399.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 399.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 552.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 478.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 539.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 539.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 539.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 547.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 427.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1003.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1528.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 626.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 608.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 552.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 556.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 626.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 556.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 478.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1003.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1528.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 608.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 552.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 172.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 172.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 552.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 399.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 402.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 172.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 589.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 547.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 552.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 427.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 552.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HEPATITIS A VIRUS VACCINE (PF) 1,440 ELISA UNIT/ML IM (SO)", "code_information": [{"code": "90632", "type": "CPT"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 166.33, "maximum": 474.11, "gross_charge": 342.95, "discounted_cash": 205.77, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 251.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 254.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 254.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 257.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 254.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 245.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 187.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 177.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 169.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 183.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 311.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 474.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 291.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 291.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 188.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 283.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 187.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 222.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 204.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 188.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 251.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 171.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 258.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 222.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 166.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 257.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 187.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 257.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 274.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 209.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 274.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 245.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 185.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 185.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 257.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 222.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 251.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 251.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 251.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 254.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 198.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 311.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 474.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 291.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 283.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 257.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 258.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 291.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 258.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 222.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 311.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 474.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 283.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 257.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 257.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 185.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 187.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 274.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 254.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 257.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 198.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 257.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HEPATITIS A VIRUS VACCINE (PF) 720 ELISA UNIT/0.5 ML INJ (SO)", "code_information": [{"code": "90633", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "minimum": 70.25, "maximum": 252.27, "gross_charge": 144.85, "discounted_cash": 86.91, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 107.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 107.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 107.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 143.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 165.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 252.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 123.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 123.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 119.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 107.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 109.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 115.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 115.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 143.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 107.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 165.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 252.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 123.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 119.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 109.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 123.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 109.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 165.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 252.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 119.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 115.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 107.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HAEMOPHILUS B POLYSACCHARID CONJ-TETANUS TOX(PF) 10 MCG/0.5 ML IM SOLN", "code_information": [{"code": "90648", "type": "CPT"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 35.24, "maximum": 84.91, "gross_charge": 72.65, "discounted_cash": 43.59, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 53.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 55.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 84.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 53.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 55.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 84.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 55.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 84.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HUMAN PAPILLOMAV VAC,9-VAL(PF) 0.5 ML IM SUSP (SO)", "code_information": [{"code": "90651", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "minimum": 243.22, "maximum": 2121.64, "gross_charge": 1336.35, "discounted_cash": 801.81, "payers_information": [{"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1392.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 2121.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 1135.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1103.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1002.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1008.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1135.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1008.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 868.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1392.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 2121.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1103.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1002.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 312.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 312.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1002.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 724.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 729.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 312.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1069.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 992.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1002.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 775.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1002.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 979.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 992.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 992.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 1002.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 992.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1247.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 729.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 690.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 660.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 716.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1392.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 2121.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1135.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 1135.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 734.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1103.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 275.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 243.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 729.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 988.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 928.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 868.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 979.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 668.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1008.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 868.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 648.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1002.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 729.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1002.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1069.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1002.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1069.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1247.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 312.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 724.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 724.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1002.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 868.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 979.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 979.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 979.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 992.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 775.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FLU VACCINE TS 2025-26(6MOS UP)(PF) 45 MCG(15MCG X3)/0.5 ML IM SYRINGE", "code_information": [{"code": "90656", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "minimum": 25.62, "maximum": 149.7, "gross_charge": 77.65, "discounted_cash": 46.59, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 75.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 98.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 149.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 75.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 98.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 149.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 98.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 149.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "RABIES VACCINE (PF) 2.5 UNIT INTRAMUSCULAR SOLUTION (SO)", "code_information": [{"code": "90675", "type": "CPT"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 319.75, "maximum": 2061.43, "gross_charge": 1817.7, "discounted_cash": 1090.62, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1332.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 1350.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1350.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 1363.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1350.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1054.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 992.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 939.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 897.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 974.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1352.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 2061.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1545.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 1545.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 999.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1501.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 319.75, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 319.75, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 992.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 1181.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 999.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 999.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 319.75, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1332.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 908.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1372.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1181.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 881.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 319.75, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1363.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 992.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1363.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1454.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 319.75, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1454.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1054.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 319.75, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 985.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 985.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1363.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1181.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1332.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1332.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1332.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1350.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1054.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1352.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 2061.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 1545.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1501.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1363.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1372.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1545.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1372.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1181.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1352.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 2061.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1501.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1363.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 319.75, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 319.75, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1363.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 985.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 992.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 319.75, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1454.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 319.75, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 319.75, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1350.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1363.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 319.75, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1054.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1363.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PNEUMOCOCCAL 20-VALENT CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE", "code_information": [{"code": "90677", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "minimum": 336.78, "maximum": 2017.27, "gross_charge": 1020.55, "discounted_cash": 612.33, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 748.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 758.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 758.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 765.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 758.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1057.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 557.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 527.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 504.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 547.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1323.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 2017.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 867.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 867.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 561.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 842.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 377.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 377.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 557.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 755.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 709.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 663.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 377.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 748.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 510.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 770.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 663.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 494.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 336.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 765.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 557.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 765.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 816.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 377.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 765.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 816.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1057.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 377.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 553.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 553.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 765.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 663.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 748.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 748.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 748.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 758.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 591.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1323.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 2017.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 867.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 842.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 765.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 770.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 867.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 770.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 663.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1323.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 2017.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 842.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 765.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 377.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 377.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 765.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 553.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 557.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 377.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 816.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 377.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 336.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 758.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 765.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 377.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 591.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 765.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ROTAVIRUS VACCINE LIVE, PENTAVALENT 2 ML ORAL SOLUTION", "code_information": [{"code": "90680", "type": "CPT"}], "drug_information": {"unit": 2, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 117.22, "maximum": 662.36, "gross_charge": 241.7, "discounted_cash": 145.02, "payers_information": [{"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 131.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 131.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 181.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 157.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 177.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 177.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 177.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 179.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 140.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 434.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 662.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 205.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 199.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 181.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 182.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 205.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 182.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 157.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 434.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 662.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 199.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 181.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 181.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 131.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 131.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 193.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 179.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 181.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 140.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 181.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 177.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 179.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 179.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 181.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 179.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 400.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 131.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 124.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 119.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 129.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 434.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 662.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 205.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 205.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 132.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 199.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 131.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 178.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 167.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 157.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 177.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 182.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 157.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 117.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 181.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 131.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 181.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 193.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 181.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 193.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 400.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DIP,PERT(A)TET-HEPB-POLIO-HIB PED(PF) 15-5 UNIT-10 MCG/0.5 ML IM (SO)", "code_information": [{"code": "90697", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "minimum": 120.09, "maximum": 1009.73, "gross_charge": 659.85, "discounted_cash": 395.91, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 483.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 490.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 490.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 494.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 490.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 632.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 360.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 341.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 325.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 353.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 662.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1009.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 560.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 560.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 362.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 545.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 135.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 360.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 488.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 458.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 428.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 483.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 329.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 498.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 428.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 320.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 494.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 360.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 494.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 527.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 494.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 527.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 632.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 154.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 357.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 357.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 494.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 428.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 483.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 483.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 483.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 490.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 382.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 662.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1009.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 560.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 545.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 494.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 498.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 560.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 498.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 428.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 662.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1009.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 545.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 494.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 154.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 154.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 494.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 357.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 360.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 154.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 527.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 490.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 494.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 382.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 494.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HAEMOPHILUS B CONJ-TET,COMPONENT 2 OF 2 (PF) 10 MCG/0.5 ML IM SOLUTION", "code_information": [{"code": "90698", "type": "CPT"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 255.3, "maximum": 774.03, "gross_charge": 526.4, "discounted_cash": 315.84, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 385.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 391.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 391.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 394.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 391.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 456.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 282.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 287.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 272.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 260.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 507.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 774.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 447.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 447.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 289.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 434.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 389.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 365.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 342.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 287.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 385.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 397.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 342.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 255.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 263.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 394.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 394.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 421.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 394.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 421.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 456.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 285.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 285.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 394.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 342.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 287.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 385.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 385.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 391.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 305.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 507.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 774.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 447.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 434.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 385.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 394.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 397.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 447.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 394.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 397.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 342.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 507.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 774.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 434.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 394.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 394.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 285.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 287.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 421.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 391.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 394.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 305.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DIP-PERT-TET-POLIO-HIB(PF) 15 LF-20 MCG-5 LF-62 DU-10MCG/0.5 ML IM KIT", "code_information": [{"code": "90698", "type": "CPT"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 242.55, "maximum": 774.03, "gross_charge": 500.1, "discounted_cash": 300.06, "payers_information": [{"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 425.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 377.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 375.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 366.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 507.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 774.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 425.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 413.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 366.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 371.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 290.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 366.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 273.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 375.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 325.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 271.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 271.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 375.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 400.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 456.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 375.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 400.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 375.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 250.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 377.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 325.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 242.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 366.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 273.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 370.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 347.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 325.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 507.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 774.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 425.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 425.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 275.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 413.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 273.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 258.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 247.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 268.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 371.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 456.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 366.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 371.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 371.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 375.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 290.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 375.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 371.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 400.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 273.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 271.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 375.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 375.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 507.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 774.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 413.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 377.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 325.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 375.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DIPH,PERTUS(ACEL),TET PEDI (PF) 25 LF UNIT-58 MCG-10 LF/0.5ML IM SUSP (SO)", "code_information": [{"code": "90700", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "minimum": 58.83, "maximum": 190.77, "gross_charge": 121.3, "discounted_cash": 72.78, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 88.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 120.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 125.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 190.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 88.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 97.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 97.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 120.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 88.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 88.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 88.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 125.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 190.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 125.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 190.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 97.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MEASLES,MUMPS,RUBELLA VACCINE LIVE(PF)1,000-12,500TCID50/0.5 ML SUBCUT", "code_information": [{"code": "90707", "type": "CPT"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 221.4, "maximum": 613.75, "gross_charge": 456.5, "discounted_cash": 273.9, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 334.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 339.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 339.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 342.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 339.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 384.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 249.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 236.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 225.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 244.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 402.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 613.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 388.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 388.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 251.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 377.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 249.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 337.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 317.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 296.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 334.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 228.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 344.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 296.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 221.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 342.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 249.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 342.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 365.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 342.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 365.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 384.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 247.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 247.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 342.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 296.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 334.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 334.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 334.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 339.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 264.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 402.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 613.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 388.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 377.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 342.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 344.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 388.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 344.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 296.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 402.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 613.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 377.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 342.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 342.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 247.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 249.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 365.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 339.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 342.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 264.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 342.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "POLIOVIRUS VACCINE 40 UNIT-8 UNIT-32 UNIT/0.5 ML INJECTION SUSPENSION", "code_information": [{"code": "90713", "type": "CPT"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 841.26, "maximum": 3082.31, "gross_charge": 1734.55, "discounted_cash": 1040.73, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1271.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 1288.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1288.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 1300.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1288.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1809.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 947.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 896.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 856.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 929.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2022.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 3082.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1474.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 1474.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 954.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1432.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 947.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 1127.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1032.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 954.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1271.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 867.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1309.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1127.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 841.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1300.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 947.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1300.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1387.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1058.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1387.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1809.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 940.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 940.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1300.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1127.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1271.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1271.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1271.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1288.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1006.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2022.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 3082.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 1474.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1432.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1300.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1309.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1474.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1309.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1127.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2022.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 3082.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1432.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1300.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1300.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 940.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 947.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1387.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1288.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1300.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1006.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1300.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DIPH,PERTUS(ACEL),TET VAC(PF) 2 LF-(2.5-5-3-5 MCG)-5LF/0.5 ML IM INJ (SO)", "code_information": [{"code": "90715", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "minimum": 114.9, "maximum": 255.88, "gross_charge": 236.9, "discounted_cash": 142.14, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 176.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 134.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 129.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 122.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 117.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 167.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 255.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 201.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 201.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 130.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 195.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 126.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 129.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 175.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 164.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 153.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 173.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 118.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 178.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 153.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 177.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 129.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 177.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 189.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 173.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 176.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 176.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 177.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 137.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 177.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 129.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 189.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 176.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 177.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 178.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 153.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 167.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 255.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 195.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 201.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 177.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 177.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 128.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 177.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 189.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 134.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 128.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 128.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 177.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 153.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 173.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 173.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 167.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 255.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 201.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 195.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 173.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 176.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 137.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 177.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 178.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DIPH,PERTUS(ACEL),TETANUS 2.5-8-5 LF-MCG-LF/0.5 ML IM INJ (SO)", "code_information": [{"code": "90715", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "minimum": 89.22, "maximum": 255.88, "gross_charge": 183.95, "discounted_cash": 110.37, "payers_information": [{"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 138.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 137.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 134.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 167.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 255.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 156.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 151.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 134.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 134.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 137.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 119.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 137.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 147.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 134.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 137.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 137.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 156.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 167.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 255.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 151.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 138.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 119.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 137.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 147.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 137.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 134.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 137.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 137.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 147.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 137.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 138.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 119.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 134.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 119.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 167.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 255.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 156.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 156.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 151.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 95.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 134.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MENINGOC VAC A,C,Y,W-135 DIP(PF) 10 MCG-5 MCG/0.5 ML IM KIT (2 VIALS)", "code_information": [{"code": "90734", "type": "CPT"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 90.15, "maximum": 1075.04, "gross_charge": 495.35, "discounted_cash": 297.21, "payers_information": [{"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 270.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 115.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 396.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 368.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 371.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 287.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 371.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 265.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 705.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1075.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 421.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 421.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 272.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 409.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 366.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 344.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 321.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 270.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 363.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 373.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 321.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 240.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 247.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 371.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 371.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 396.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 371.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 396.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 675.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 270.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 115.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 268.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 268.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 371.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 321.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 363.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 363.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 363.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 368.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 287.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 705.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1075.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 421.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 409.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 371.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 373.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 373.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 321.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 705.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1075.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 409.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 421.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 371.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 115.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 115.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 371.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 268.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 363.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 368.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 368.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 371.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 368.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 675.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 270.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 256.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 244.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MENINGOCOCCAL A CONJ VACC 2 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION", "code_information": [{"code": "90734", "type": "CPT"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 90.15, "maximum": 1075.04, "gross_charge": 495.35, "discounted_cash": 297.21, "payers_information": [{"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 265.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 256.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 244.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 705.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1075.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 421.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 421.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 272.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 409.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 373.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 321.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 240.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 363.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 270.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 366.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 344.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 321.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 363.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 368.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 287.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 363.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 363.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 371.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 321.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 268.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 268.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 115.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 270.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 371.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 396.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 675.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 371.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 396.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 371.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 247.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 268.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 371.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 115.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 115.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 371.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 421.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 705.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1075.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 409.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 373.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 321.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 373.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 371.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 705.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1075.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 421.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 409.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 371.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 287.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 371.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 368.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 396.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 115.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 270.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 270.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 368.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 675.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 363.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 368.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 368.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 371.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HEPATITIS B VIRUS VACCINE RECOMB (PF) 40 MCG/ML INTRAMUSCULAR SUSP", "code_information": [{"code": "90740", "type": "CPT"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 162.51, "maximum": 1060.02, "gross_charge": 492.45, "discounted_cash": 295.47, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 360.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 365.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 365.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 369.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 365.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 555.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 268.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 254.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 243.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 695.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1060.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 418.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 418.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 406.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 182.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 182.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 268.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 364.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 342.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 320.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 182.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 360.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 246.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 371.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 320.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 238.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 162.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 369.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 268.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 369.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 182.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 369.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 393.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 555.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 182.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 266.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 266.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 320.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 360.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 360.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 360.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 365.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 285.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 695.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1060.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 418.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 406.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 369.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 371.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 418.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 371.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 320.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 695.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1060.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 406.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 182.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 182.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 369.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 266.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 268.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 182.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 182.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 162.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 365.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 369.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 182.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 285.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 369.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HEPATITIS B VIRUS VACC.REC(PF) 10 MCG/0.5 ML INJ (SO)", "code_information": [{"code": "90744", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "minimum": 35.59, "maximum": 214.04, "gross_charge": 107.85, "discounted_cash": 64.71, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 107.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 140.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 214.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 107.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 140.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 214.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 140.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 214.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HEPATITIS B VIRUS VACC.REC(PF) 20 MCG/ML INJ (SO)", "code_information": [{"code": "90746", "type": "CPT"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 75.59, "maximum": 484.49, "gross_charge": 229.05, "discounted_cash": 137.43, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 167.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 170.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 170.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 171.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 170.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 237.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 125.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 118.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 113.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 122.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 317.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 484.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 194.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 194.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 125.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 189.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 125.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 148.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 125.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 167.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 172.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 148.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 111.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 171.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 125.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 171.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 183.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 139.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 183.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 237.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 124.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 124.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 171.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 148.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 167.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 167.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 167.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 170.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 132.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 317.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 484.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 194.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 189.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 171.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 172.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 194.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 172.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 148.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 317.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 484.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 189.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 171.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 171.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 124.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 125.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 183.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 170.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 171.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 132.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 171.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "VARICELLA-ZOSTER GLYCOE VACC-AS01B ADJ(PF) 50 MCG/0.5 ML IM SUSP, KIT", "code_information": [{"code": "90750", "type": "CPT"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 122.34, "maximum": 1389.39, "gross_charge": 672.2, "discounted_cash": 403.32, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 492.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 499.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 499.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 504.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 499.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 367.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 347.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 332.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 360.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 911.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1389.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 571.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 571.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 369.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 555.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 138.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 122.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 367.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 436.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 399.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 369.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 492.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 336.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 507.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 436.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 326.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 504.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 367.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 504.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 537.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 410.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 537.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 157.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 364.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 364.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 504.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 436.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 492.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 492.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 492.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 499.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 389.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 911.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1389.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 571.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 555.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 504.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 507.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 571.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 507.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 436.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 911.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1389.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 555.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 504.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 157.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 157.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 504.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 364.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 367.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 157.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 537.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 499.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 504.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 389.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 504.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "COVID VACC 2025-2026 (12 YRS UP) (PFIZER)(PF) 30 MCG/0.3 ML IM SYRINGE", "code_information": [{"code": "91320", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "minimum": 160.97, "maximum": 1085.48, "gross_charge": 487.8, "discounted_cash": 292.68, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 357.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 362.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 362.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 365.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 362.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 526.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 266.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 252.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 240.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 261.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 712.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1085.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 414.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 414.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 268.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 402.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 180.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 180.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 266.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 360.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 339.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 317.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 180.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 357.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 243.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 368.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 317.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 236.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 160.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 365.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 266.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 365.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 390.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 180.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 365.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 390.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 526.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 180.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 264.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 264.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 365.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 317.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 357.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 357.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 357.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 362.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 282.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 712.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1085.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 414.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 402.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 365.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 368.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 414.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 368.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 317.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 712.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1085.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 402.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 365.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 180.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 180.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 365.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 264.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 266.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 180.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 390.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 180.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 160.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 362.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 365.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 180.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 282.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 365.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "COVID VAC 2025-26 (6MO-11YR)(MODERNA) (PF) 25 MCG/0.25 ML IM SYRINGE", "code_information": [{"code": "91321", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "minimum": 202.21, "maximum": 497.06, "gross_charge": 612.75, "discounted_cash": 367.65, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 449.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 497.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 302.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 328.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 337.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 226.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 226.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 337.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 226.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 449.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 306.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 202.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 490.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 226.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 490.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 497.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 226.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 332.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 459.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 449.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 449.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 449.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 355.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 459.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 226.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 226.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 332.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 226.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 490.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 226.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 202.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 226.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 355.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SILDENAFIL (PULMONARY HYPERTENSION) 10 MG/12.5 ML INTRAVENOUS SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 12, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 314.91, "maximum": 434.36, "gross_charge": 542.95, "discounted_cash": 325.77, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 434.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 387.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 314.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 387.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 314.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FLUORESCEIN 500 MG/5 ML (10 %) INTRAVENOUS SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 167.45, "maximum": 230.96, "gross_charge": 288.7, "discounted_cash": 173.22, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 167.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 230.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 205.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 167.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 205.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "GLYCOPYRROLATE 1 MG TABLET", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.29, "maximum": 0.4, "gross_charge": 0.5, "discounted_cash": 0.3, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HYDROCHLORIC ACID (BULK) 37 % LIQUID", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 500, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 27.41, "maximum": 37.8, "gross_charge": 47.25, "discounted_cash": 28.35, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 435.9, "maximum": 601.24, "gross_charge": 751.55, "discounted_cash": 450.93, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 601.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 535.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 435.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 435.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 535.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "INDOMETHACIN 1 MG INTRAVENOUS SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 692.14, "maximum": 954.68, "gross_charge": 1193.35, "discounted_cash": 716.01, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 850.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 692.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 692.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 954.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 850.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJECTION SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 11.86, "maximum": 16.36, "gross_charge": 20.45, "discounted_cash": 12.27, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJECTION SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 25.96, "maximum": 35.8, "gross_charge": 44.75, "discounted_cash": 26.85, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "VARICELLA VIRUS VACCINE LIVE (PF) 1,350 UNIT/0.5 ML SUBCUTANEOUS SUSP", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 479.08, "maximum": 660.8, "gross_charge": 826.0, "discounted_cash": 495.6, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 660.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 588.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 479.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 588.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 479.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TROMETHAMINE 36 MG/ML (0.3 M) INTRAVENOUS SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 500, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 496.34, "maximum": 684.6, "gross_charge": 855.75, "discounted_cash": 513.45, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 496.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 684.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 610.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 496.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 610.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "VECURONIUM BROMIDE 10 MG INTRAVENOUS SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 8.64, "maximum": 11.92, "gross_charge": 14.9, "discounted_cash": 8.94, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 13.66, "maximum": 18.84, "gross_charge": 23.55, "discounted_cash": 14.13, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ISOPROTERENOL 0.2 MG/ML INJECTION SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 503.85, "maximum": 694.96, "gross_charge": 868.7, "discounted_cash": 521.22, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 694.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 619.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 503.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 503.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 619.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CUPRIC CHLORIDE 0.4 MG/ML INTRAVENOUS SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 52.2, "maximum": 72.0, "gross_charge": 90.0, "discounted_cash": 54.0, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "AMINO ACID 10 % (TROPHAMINE) INTRAVENOUS SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 500, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 136.74, "maximum": 188.6, "gross_charge": 235.75, "discounted_cash": 141.45, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 188.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 168.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 168.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DEXMEDETOMIDINE 200 MCG/50 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 24.65, "maximum": 34.0, "gross_charge": 42.5, "discounted_cash": 25.5, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DEXMEDETOMIDINE 400 MCG/100 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 100, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 47.36, "maximum": 65.32, "gross_charge": 81.65, "discounted_cash": 48.99, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ACETYLCYSTEINE 100 MG/ML (10 %) SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 4, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 12.88, "maximum": 17.76, "gross_charge": 22.2, "discounted_cash": 13.32, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DORNASE ALFA 1 MG/ML SOLUTION FOR INHALATION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 2, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 187.2, "maximum": 258.2, "gross_charge": 322.75, "discounted_cash": 193.65, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 187.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 230.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 258.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 230.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 187.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 2, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 6.7, "maximum": 9.24, "gross_charge": 11.55, "discounted_cash": 6.93, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "BALANCED SALT SOLUTION COMBINATION NO.2 INTRAOCULAR IRRIGATION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 15, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 4.99, "maximum": 13.2, "gross_charge": 8.6, "discounted_cash": 5.16, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "BALANCED SALT SOLUTION COMBINATION NO.2 INTRAOCULAR IRRIGATION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 500, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 4.99, "maximum": 13.2, "gross_charge": 16.5, "discounted_cash": 9.9, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LIRAGLUTIDE 0.6 MG/0.1 ML (18 MG/3 ML) SUBCUTANEOUS PEN INJECTOR", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 3, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 718.77, "maximum": 991.4, "gross_charge": 1239.25, "discounted_cash": 743.55, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 718.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 718.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 883.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 991.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 883.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CANDIDA ALBICANS SKIN TEST FDA STANDARD INTRADERMAL", "code_information": [{"code": "2500003", "type": "CDM"}], "standard_charges": [{"setting": "outpatient", "minimum": 89.67, "maximum": 123.68, "gross_charge": 154.6, "discounted_cash": 92.76, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 123.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 110.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 110.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MVI, PEDI NO.1 WITH VIT K 80 MG-400 UNIT-200 MCG/5 ML INTRAVENOUS SOLN", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 389.62, "maximum": 537.4, "gross_charge": 671.75, "discounted_cash": 403.05, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 389.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 389.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 478.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 537.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 478.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "METHYLCELLULOSE 4000CPS (BULK) 30 % POWDER", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 100, "type": "GR"}, "standard_charges": [{"setting": "outpatient", "minimum": 14.62, "maximum": 20.16, "gross_charge": 25.2, "discounted_cash": 15.12, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 2, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.55, "maximum": 0.76, "gross_charge": 0.95, "discounted_cash": 0.57, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PORACTANT ALFA 240 MG/3 ML INTRATRACHEAL SUSPENSION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 3, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 1996.65, "maximum": 2754.0, "gross_charge": 3442.5, "discounted_cash": 2065.5, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2754.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2454.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2454.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1996.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1996.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ARTICAINE 4 %-EPINEPHRINE BITARTRATE 1:200,000 INJECTION CARTRIDGE", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 4.21, "maximum": 5.8, "gross_charge": 7.25, "discounted_cash": 4.35, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ANAKINRA 100 MG/0.67 ML SUBCUTANEOUS SYRINGE", "code_information": [{"code": "2500003", "type": "CDM"}], "standard_charges": [{"setting": "outpatient", "minimum": 573.19, "maximum": 790.6, "gross_charge": 988.25, "discounted_cash": 592.95, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 790.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 704.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 704.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 573.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 573.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "POTASSIUM PHOSPHATES-MBASIC AND DIBASIC 3 MMOL/ML INTRAVENOUS SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 36.25, "maximum": 50.0, "gross_charge": 62.5, "discounted_cash": 37.5, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PYRIDOSTIGMINE BROMIDE 5 MG/ML INJECTION SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 2, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 83.84, "maximum": 115.64, "gross_charge": 144.55, "discounted_cash": 86.73, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 115.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 4, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 7.57, "maximum": 10.44, "gross_charge": 13.05, "discounted_cash": 7.83, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PARENTERAL AMINO ACID 10 % COMBINATION NO.6 INTRAVENOUS SOLUTION (TRAVASOL)", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 2000, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 86.71, "maximum": 119.6, "gross_charge": 149.5, "discounted_cash": 89.7, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 119.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PRISMASOL BGK 2-0 DIALYSATE SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 5000, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 108.75, "maximum": 150.0, "gross_charge": 187.5, "discounted_cash": 112.5, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 133.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 150.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 133.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "NOREPINEPHRINE BITARTRATE 4 MG/250 ML (16 MCG/ML) IN 0.9 % NACL IV", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 250, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 68.88, "maximum": 95.0, "gross_charge": 118.75, "discounted_cash": 71.25, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 95.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PRISMASOL BGK 4-0-1.2 DIALYSATE SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 5000, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 91.35, "maximum": 126.0, "gross_charge": 157.5, "discounted_cash": 94.5, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 126.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "NOREPINEPHRINE BITARTRATE 8 MG/250 ML (32 MCG/ML) IN 0.9 % NACL IV", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 250, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 81.58, "maximum": 112.52, "gross_charge": 140.65, "discounted_cash": 84.39, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ROCURONIUM 100 MG/10 ML (10 MG/ML) INTRAVENOUS SYRINGE", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 49.71, "maximum": 68.56, "gross_charge": 85.7, "discounted_cash": 51.42, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PRISMASOL B22GK 4-0 DIALYSATE SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 5000, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 91.35, "maximum": 126.0, "gross_charge": 157.5, "discounted_cash": 94.5, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 126.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "METHYLCELLULOSE 1500CPS (BULK) 27.5 % TO 31.5 % (USP) POWDER", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 100, "type": "GR"}, "standard_charges": [{"setting": "outpatient", "minimum": 15.66, "maximum": 21.6, "gross_charge": 27.0, "discounted_cash": 16.2, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "NOREPINEPHRINE BITARTRATE 16 MG/250 ML (64 MCG/ML) IN 0.9 % NACL IV", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 250, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 142.36, "maximum": 196.36, "gross_charge": 245.45, "discounted_cash": 147.27, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 142.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 196.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 175.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 175.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 142.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SODIUM CHLORIDE (BULK) POWDER", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 500, "type": "GR"}, "standard_charges": [{"setting": "outpatient", "minimum": 14.79, "maximum": 20.4, "gross_charge": 25.5, "discounted_cash": 15.3, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MENINGOCO C,Y,W-135 VACC 1 OF 2(PF) 5 MCG X3/0.5 ML(FINAL) IM SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "standard_charges": [{"setting": "outpatient", "minimum": 143.67, "maximum": 198.16, "gross_charge": 247.7, "discounted_cash": 148.62, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 198.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 176.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 176.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 143.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 143.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SULFADIAZINE (BULK) POWDER", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 500, "type": "GR"}, "standard_charges": [{"setting": "outpatient", "minimum": 42.2, "maximum": 58.2, "gross_charge": 72.75, "discounted_cash": 43.65, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "GLUTAMINE (BULK) POWDER", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 100, "type": "GR"}, "standard_charges": [{"setting": "outpatient", "minimum": 17.14, "maximum": 23.64, "gross_charge": 29.55, "discounted_cash": 17.73, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "VALINE (BULK) POWDER", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 100, "type": "GR"}, "standard_charges": [{"setting": "outpatient", "minimum": 19.75, "maximum": 27.24, "gross_charge": 34.05, "discounted_cash": 20.43, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ISOLEUCINE (BULK) POWDER", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 100, "type": "GR"}, "standard_charges": [{"setting": "outpatient", "minimum": 49.59, "maximum": 68.4, "gross_charge": 85.5, "discounted_cash": 51.3, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ASCORBATE SODIUM (VITAMIN C) (BULK) 100% POWDER", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 100, "type": "GR"}, "standard_charges": [{"setting": "outpatient", "minimum": 22.62, "maximum": 31.2, "gross_charge": 39.0, "discounted_cash": 23.4, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SEVOFLURANE 99.97 % INHALATION LIQUID", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 250, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 116.87, "maximum": 161.2, "gross_charge": 201.5, "discounted_cash": 120.9, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 161.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 143.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 143.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 116.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 116.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MEPIVACAINE 30 MG/ML (3 %) INJECTION DENTAL CARTRIDGE", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 2.78, "maximum": 3.84, "gross_charge": 4.8, "discounted_cash": 2.88, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SUGAMMADEX 100 MG/ML INTRAVENOUS SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 2, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 361.02, "maximum": 497.96, "gross_charge": 622.45, "discounted_cash": 373.47, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 361.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 497.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 443.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 443.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 361.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DEFIBROTIDE 80 MG/ML INTRAVENOUS SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 2, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 2688.3, "maximum": 3708.0, "gross_charge": 4635.0, "discounted_cash": 2781.0, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2688.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2688.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3304.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3708.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3304.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DINUTUXIMAB 3.5 MG/ML INTRAVENOUS SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 51819.32, "maximum": 71474.92, "gross_charge": 89343.65, "discounted_cash": 53606.19, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71474.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 63702.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 51819.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 51819.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 63702.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PHOXILLUM BK 4-2.5 DIALYSATE SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 5000, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 126.88, "maximum": 175.0, "gross_charge": 218.75, "discounted_cash": 131.25, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 126.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 155.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 175.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 155.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 126.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "INSULIN REGULAR HUMAN U-500 (CONCENTRATE) 500 UNIT/ML(3 ML) SUBCUT PEN", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 3, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 640.67, "maximum": 883.68, "gross_charge": 1104.6, "discounted_cash": 662.76, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 640.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 883.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 787.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 787.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 640.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "BRIVARACETAM 50 MG/5 ML INTRAVENOUS SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 17.43, "maximum": 24.04, "gross_charge": 30.05, "discounted_cash": 18.03, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "BOTULISM IMMUNE GLOBULIN, HUMAN 100 MG INTRAVENOUS SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 180873.0, "maximum": 249480.0, "gross_charge": 311850.0, "discounted_cash": 187110.0, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 222349.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 180873.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 180873.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 249480.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 222349.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CHLORPROMAZINE 100 MG TABLET", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 12.53, "maximum": 17.28, "gross_charge": 21.6, "discounted_cash": 12.96, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "VENETOCLAX 50 MG TABLET", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 130.5, "maximum": 180.0, "gross_charge": 225.0, "discounted_cash": 135.0, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 160.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 130.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 130.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 180.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 160.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "VENETOCLAX 100 MG TABLET", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 223.65, "maximum": 308.48, "gross_charge": 385.6, "discounted_cash": 231.36, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 308.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 274.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 223.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 223.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 274.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LIDOCAINE 0.9% BUFFERED (0.5 ML) INJ SYRINGE", "code_information": [{"code": "2500003", "type": "CDM"}], "standard_charges": [{"setting": "outpatient", "minimum": 0.12, "maximum": 0.16, "gross_charge": 0.2, "discounted_cash": 0.12, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CITRIC ACID (BULK) POWDER", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 100, "type": "GR"}, "standard_charges": [{"setting": "outpatient", "minimum": 6.7, "maximum": 9.24, "gross_charge": 11.55, "discounted_cash": 6.93, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "REMIFENTANIL 1 MG INTRAVENOUS SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 77.29, "maximum": 106.6, "gross_charge": 133.25, "discounted_cash": 79.95, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 95.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 95.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "REMIFENTANIL 2 MG INTRAVENOUS SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 222.63, "maximum": 307.08, "gross_charge": 383.85, "discounted_cash": 230.31, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 307.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 273.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 222.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 222.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 273.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "METHYLENE BLUE (ANTIDOTE) 5 MG/ML INTRAVENOUS SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 167.07, "maximum": 230.44, "gross_charge": 288.05, "discounted_cash": 172.83, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 167.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 230.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 205.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 205.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 167.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 2, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 38.22, "maximum": 52.72, "gross_charge": 65.9, "discounted_cash": 39.54, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TOPIRAMATE 25 MG TABLET", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.58, "maximum": 0.8, "gross_charge": 1.0, "discounted_cash": 0.6, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ARGININE (L-ARGININE) ORAL POWDER", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 50, "type": "GR"}, "standard_charges": [{"setting": "outpatient", "minimum": 18.71, "maximum": 25.8, "gross_charge": 32.25, "discounted_cash": 19.35, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LETERMOVIR 240 MG TABLET", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 318.3, "maximum": 439.04, "gross_charge": 548.8, "discounted_cash": 329.28, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 439.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 391.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 318.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 391.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 318.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ANGIOTENSIN II 2.5 MG/ML INTRAVENOUS SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 4549.09, "maximum": 6274.6, "gross_charge": 7843.25, "discounted_cash": 4705.95, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4549.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5592.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4549.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6274.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5592.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ASCORBIC ACID (VITAMIN C) 500 MG/ML INTRAVENOUS SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 681.73, "maximum": 940.32, "gross_charge": 1175.4, "discounted_cash": 705.24, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 838.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 681.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 940.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 838.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 681.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CARBACHOL 0.01 % INTRAOCULAR SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 46.86, "maximum": 64.64, "gross_charge": 80.8, "discounted_cash": 48.48, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "KETAMINE 30 MG/3 ML (10 MG/ML) IN SODIUM CHLOR,ISO-OSMOTIC INJ SYRINGE", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 3, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 21.4, "maximum": 29.52, "gross_charge": 36.9, "discounted_cash": 22.14, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ETHYL ALCOHOL 99 % INTRA-ARTERIAL SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 1589.75, "maximum": 2192.76, "gross_charge": 2740.95, "discounted_cash": 1644.57, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1589.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2192.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1954.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1589.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1954.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DEXTROSE 2.45 GRAM-SOD CITRATE 2.2 GRAM-CITRIC AC 800 MG/100 ML SOLN", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 750, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 16.33, "maximum": 22.52, "gross_charge": 28.15, "discounted_cash": 16.89, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SELENIUM 60 MCG/ML INTRAVENOUS SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 739.91, "maximum": 1020.56, "gross_charge": 1275.7, "discounted_cash": 765.42, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 739.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 909.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 739.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1020.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 909.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 6.21, "maximum": 8.56, "gross_charge": 10.7, "discounted_cash": 6.42, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "EPHEDRINE SULFATE 5 MG/ML INTRAVENOUS SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 30.83, "maximum": 42.52, "gross_charge": 53.15, "discounted_cash": 31.89, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "EDETATE DISODIUM (BULK) 100 % POWDER", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 100, "type": "GR"}, "standard_charges": [{"setting": "outpatient", "minimum": 17.4, "maximum": 24.0, "gross_charge": 30.0, "discounted_cash": 18.0, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LIDOCAINE 0.9% BUFFERED WITH SODIUM PHOSPHATE (1 ML) INJECTION SYRINGE", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 27.93, "maximum": 38.52, "gross_charge": 48.15, "discounted_cash": 28.89, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MOMETASONE 50 MCG/ACTUATION NASAL SPRAY", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 17, "type": "GR"}, "standard_charges": [{"setting": "outpatient", "minimum": 33.52, "maximum": 46.24, "gross_charge": 57.8, "discounted_cash": 34.68, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TOBRAMYCIN 300 MG/5 ML IN 0.225 % SODIUM CHLORIDE FOR NEBULIZATION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 31.49, "maximum": 43.44, "gross_charge": 54.3, "discounted_cash": 32.58, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LIDOCAINE 4 %-EPINEPHRINE 0.09 %-TETRACAINE 0.5 % TOPICAL GEL", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 3, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 22.42, "maximum": 30.92, "gross_charge": 38.65, "discounted_cash": 23.19, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PHYSOSTIGMINE 0.4 MG/ML INTRAVENOUS SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 380.63, "maximum": 525.0, "gross_charge": 656.25, "discounted_cash": 393.75, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 380.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 467.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 380.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 525.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 467.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "BECLOMETHASONE DIPROP (BULK) POWDER", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 5, "type": "GR"}, "standard_charges": [{"setting": "outpatient", "minimum": 119.8, "maximum": 165.24, "gross_charge": 206.55, "discounted_cash": 123.93, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 147.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 119.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 165.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 147.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 119.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DEXAMETHASONE 0.5 MG TABLET", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.26, "maximum": 0.36, "gross_charge": 0.45, "discounted_cash": 0.27, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DEXTROSE 25 % IN WATER (D25W) INTRAVENOUS SYRINGE", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 59.91, "maximum": 82.64, "gross_charge": 103.3, "discounted_cash": 61.98, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DEXTROSE 70 % IN WATER (D70W) INTRAVENOUS SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 2000, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 36.25, "maximum": 50.0, "gross_charge": 62.5, "discounted_cash": 37.5, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "METHOXSALEN 20 MCG/ML INJECTION SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 3202.24, "maximum": 4416.88, "gross_charge": 5521.1, "discounted_cash": 3312.66, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3936.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3202.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4416.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3936.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3202.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ALBUTEROL SULFATE CONCENTRATE 5 MG/ML(0.5 %) SOLUTION FOR NEBULIZATION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 20, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 63.63, "maximum": 120.0, "gross_charge": 150.0, "discounted_cash": 90.0, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ALBUTEROL SULFATE CONCENTRATE 5 MG/ML(0.5 %) SOLUTION FOR NEBULIZATION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 30, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 63.63, "maximum": 120.0, "gross_charge": 109.7, "discounted_cash": 65.82, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ELECTROLYTE-A INTRAVENOUS SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 1000, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 10.88, "maximum": 15.0, "gross_charge": 18.75, "discounted_cash": 11.25, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PENTAMIDINE 300 MG SOLUTION FOR INHALATION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 117.04, "maximum": 161.44, "gross_charge": 201.8, "discounted_cash": 121.08, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 117.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 143.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 117.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 161.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 143.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LIDOCAINE-TRANSPARENT DRESSING 4 % TOPICAL KIT", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 5, "type": "GR"}, "standard_charges": [{"setting": "outpatient", "minimum": 6.53, "maximum": 9.0, "gross_charge": 11.25, "discounted_cash": 6.75, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HEP B-DP(A)T-POLIO VACC (PF) 10 MCG-25LF-25 MCG-10LF/0.5 ML IM SYRINGE", "code_information": [{"code": "2500003", "type": "CDM"}], "standard_charges": [{"setting": "outpatient", "minimum": 190.15, "maximum": 262.28, "gross_charge": 327.85, "discounted_cash": 196.71, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 190.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 233.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 190.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 262.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 233.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "GLYCINE (BULK) POWDER", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 100, "type": "GR"}, "standard_charges": [{"setting": "outpatient", "minimum": 13.05, "maximum": 18.0, "gross_charge": 22.5, "discounted_cash": 13.5, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CITRATE DEXTROSE SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 1000, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 25.38, "maximum": 35.0, "gross_charge": 43.75, "discounted_cash": 26.25, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "STERILE TALC 5 GRAM INTRAPLEURAL SUSPENSION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 283.48, "maximum": 391.0, "gross_charge": 488.75, "discounted_cash": 293.25, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 348.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 283.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 391.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 348.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 283.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 9.11, "maximum": 12.56, "gross_charge": 15.7, "discounted_cash": 9.42, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SODIUM BICARBONATE INFUSION 1 MEQ/ML", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 32.28, "maximum": 44.52, "gross_charge": 55.65, "discounted_cash": 33.39, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "INSULIN SUBCUTANEOUS PUMP (NOVOLOG) 100 UNIT/ML INSULIN PUMP INFUSION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.12, "maximum": 0.16, "gross_charge": 0.2, "discounted_cash": 0.12, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SODIUM BENZOATE 10 %-SODIUM PHENYLACETATE 10 % INTRAVENOUS SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 21479.26, "maximum": 29626.56, "gross_charge": 37033.2, "discounted_cash": 22219.92, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29626.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26404.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 21479.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26404.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 21479.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PHENOL (BULK) 89 % LIQUID", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.1, "maximum": 1.52, "gross_charge": 1.9, "discounted_cash": 1.14, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SODIUM TETRADECYL SULFATE 3 % (30 MG/ML) INTRAVENOUS SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 2, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 216.98, "maximum": 299.28, "gross_charge": 374.1, "discounted_cash": 224.46, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 299.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 266.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 216.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 266.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 216.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "KETAMINE 10 MG/ML INJECTION SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 2, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 4.15, "maximum": 52.6, "gross_charge": 7.15, "discounted_cash": 4.29, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "KETAMINE 10 MG/ML INJECTION SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 20, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 4.15, "maximum": 52.6, "gross_charge": 65.75, "discounted_cash": 39.45, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "KETAMINE 100 MG/ML INJECTION SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 29.75, "maximum": 41.04, "gross_charge": 51.3, "discounted_cash": 30.78, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CYSTEINE (L-CYSTEINE) 50 MG/ML INTRAVENOUS SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 266.68, "maximum": 367.84, "gross_charge": 459.8, "discounted_cash": 275.88, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 266.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 327.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 266.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 367.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 327.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LIDOCAINE HCL 4 % LARYNGOTRACHEAL SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 4, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 79.14, "maximum": 109.16, "gross_charge": 136.45, "discounted_cash": 81.87, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 97.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 109.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 97.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MANNITOL 20 % INTRAVENOUS SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 500, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 50.03, "maximum": 69.0, "gross_charge": 86.25, "discounted_cash": 51.75, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LEECHES, MEDICINAL", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 130.15, "maximum": 179.52, "gross_charge": 224.4, "discounted_cash": 134.64, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 179.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 160.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 130.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 160.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 130.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DEXTROSE 10% STARTER TPN 250 ML", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 250, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 6.87, "maximum": 9.48, "gross_charge": 11.85, "discounted_cash": 7.11, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DEXTROSE 5% STARTER TPN 250 ML", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 250, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 28.83, "maximum": 39.76, "gross_charge": 49.7, "discounted_cash": 29.82, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "KETAMINE INFUSION 10 MG/ML (PEDIATRICS)", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.52, "maximum": 148.2, "gross_charge": 46.35, "discounted_cash": 27.81, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "KETAMINE INFUSION 10 MG/ML (PEDIATRICS)", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 20, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.52, "maximum": 148.2, "gross_charge": 92.65, "discounted_cash": 55.59, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "KETAMINE INFUSION 10 MG/ML (PEDIATRICS)", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 200, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.52, "maximum": 148.2, "gross_charge": 0.9, "discounted_cash": 0.54, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "KETAMINE INFUSION 10 MG/ML (PEDIATRICS)", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 3, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.52, "maximum": 148.2, "gross_charge": 13.9, "discounted_cash": 8.34, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "KETAMINE INFUSION 10 MG/ML (PEDIATRICS)", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 30, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.52, "maximum": 148.2, "gross_charge": 138.95, "discounted_cash": 83.37, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 111.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "KETAMINE INFUSION 10 MG/ML (PEDIATRICS)", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 40, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.52, "maximum": 148.2, "gross_charge": 185.25, "discounted_cash": 111.15, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 107.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 132.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 107.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 148.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 132.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "KETAMINE INFUSION 10 MG/ML (PEDIATRICS)", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.52, "maximum": 148.2, "gross_charge": 23.2, "discounted_cash": 13.92, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "KETAMINE INFUSION 10 MG/ML (PEDIATRICS)", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.52, "maximum": 148.2, "gross_charge": 9.35, "discounted_cash": 5.61, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "BUMETANIDE INFUSION 0.25 MG/ML", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 7.22, "maximum": 9.96, "gross_charge": 12.45, "discounted_cash": 7.47, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DEXMEDETOMIDINE IV SYRINGE 4 MCG/ML", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.77, "maximum": 48.0, "gross_charge": 6.5, "discounted_cash": 3.9, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DEXMEDETOMIDINE IV SYRINGE 4 MCG/ML", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 20, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.77, "maximum": 48.0, "gross_charge": 60.0, "discounted_cash": 36.0, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DEXMEDETOMIDINE IV SYRINGE 4 MCG/ML", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.77, "maximum": 48.0, "gross_charge": 58.45, "discounted_cash": 35.07, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DOXYCYCLINE IV SYRINGE 1 MG/ML (PEDIATRICS)", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 32.71, "maximum": 45.12, "gross_charge": 56.4, "discounted_cash": 33.84, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "NAFCILLIN IV SYRINGE 40 MG/ML (PEDIATRICS)", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 31.12, "maximum": 42.92, "gross_charge": 53.65, "discounted_cash": 32.19, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LIDOCAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION (SO)", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 5.19, "maximum": 12.72, "gross_charge": 12.1, "discounted_cash": 7.26, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LIDOCAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION (SO)", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 2, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 5.19, "maximum": 12.72, "gross_charge": 15.9, "discounted_cash": 9.54, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LIDOCAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION (SO)", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 5.19, "maximum": 12.72, "gross_charge": 8.95, "discounted_cash": 5.37, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) INTRAVENOUS SOLUTION (SO)", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 13.92, "maximum": 19.2, "gross_charge": 24.0, "discounted_cash": 14.4, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ARGININE HCL (L-ARGININE) 10 % IV INFUSION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.39, "maximum": 168.96, "gross_charge": 8.0, "discounted_cash": 4.8, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ARGININE HCL (L-ARGININE) 10 % IV INFUSION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 20, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.39, "maximum": 168.96, "gross_charge": 16.0, "discounted_cash": 9.6, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ARGININE HCL (L-ARGININE) 10 % IV INFUSION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 3, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.39, "maximum": 168.96, "gross_charge": 2.4, "discounted_cash": 1.44, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ARGININE HCL (L-ARGININE) 10 % IV INFUSION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 30, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.39, "maximum": 168.96, "gross_charge": 24.0, "discounted_cash": 14.4, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ARGININE HCL (L-ARGININE) 10 % IV INFUSION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 300, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.39, "maximum": 168.96, "gross_charge": 211.2, "discounted_cash": 126.72, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 168.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 150.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 122.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 150.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 122.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ARGININE HCL (L-ARGININE) 10 % IV INFUSION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.39, "maximum": 168.96, "gross_charge": 4.0, "discounted_cash": 2.4, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ARGININE HCL (L-ARGININE) 10 % IV INFUSION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.39, "maximum": 168.96, "gross_charge": 41.6, "discounted_cash": 24.96, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LEVOTHYROXINE IV SYRINGE 20 MCG/ML (PEDIATRICS)", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 313.03, "maximum": 431.76, "gross_charge": 539.7, "discounted_cash": 323.82, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 313.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 384.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 313.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 431.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 384.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DEXMEDETOMIDINE IVPB 4 MCG/ML", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 100, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 47.36, "maximum": 65.32, "gross_charge": 81.65, "discounted_cash": 48.99, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CISATRACURIUM INFUSION 2 MG/ML", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 20, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 37.32, "maximum": 51.48, "gross_charge": 64.35, "discounted_cash": 38.61, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "VECURONIUM INFUSION 1 MG/ML (SYRINGE) (PEDIATRICS)", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 20, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 36.28, "maximum": 50.04, "gross_charge": 62.55, "discounted_cash": 37.53, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SILDENAFIL INFUSION 0.8 MG/ML", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 12, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 218.86, "maximum": 5030.88, "gross_charge": 742.95, "discounted_cash": 445.77, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 430.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 594.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 529.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 430.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 529.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SILDENAFIL INFUSION 0.8 MG/ML", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 25, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 218.86, "maximum": 5030.88, "gross_charge": 3144.3, "discounted_cash": 1886.58, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1823.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2515.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2241.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1823.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2241.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SILDENAFIL INFUSION 0.8 MG/ML", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 3, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 218.86, "maximum": 5030.88, "gross_charge": 377.35, "discounted_cash": 226.41, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 218.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 301.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 269.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 218.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 269.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SILDENAFIL INFUSION 0.8 MG/ML", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 37, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 218.86, "maximum": 5030.88, "gross_charge": 4779.35, "discounted_cash": 2867.61, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2772.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3823.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3407.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2772.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3407.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SILDENAFIL INFUSION 0.8 MG/ML", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 218.86, "maximum": 5030.88, "gross_charge": 628.9, "discounted_cash": 377.34, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 364.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 503.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 448.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 364.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 448.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SILDENAFIL INFUSION 0.8 MG/ML", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 218.86, "maximum": 5030.88, "gross_charge": 6288.6, "discounted_cash": 3773.16, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3647.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5030.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4483.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3647.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4483.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PYRIDOXAL 5-PHOSPHATE 50 MG CAPSULE", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.49, "maximum": 0.68, "gross_charge": 0.85, "discounted_cash": 0.51, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "EPHEDRINE SULFATE 50 MG/ML INJECTION SOLUTION (SO)", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 14.59, "maximum": 20.12, "gross_charge": 25.15, "discounted_cash": 15.09, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "INSULIN GLARGINE 100 UNIT/ML SUBCUTANEOUS SYRINGE", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 1000, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 170.78, "maximum": 235.56, "gross_charge": 294.45, "discounted_cash": 176.67, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 209.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 170.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 235.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 209.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 170.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SODIUM CHLORIDE 4 MEQ/ML IV SOLUTION (USES SYSTEM ROUNDING)", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 100, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 43.15, "maximum": 59.52, "gross_charge": 74.4, "discounted_cash": 44.64, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MANNITOL 20% INTRAVENOUS SOLUTION (PEDIATRICS)", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 500, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 50.03, "maximum": 69.0, "gross_charge": 86.25, "discounted_cash": 51.75, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ALBUTEROL SULFATE CONCENTRATE 5 MG/ML(0.5 %) SOLUTION FOR CONTINUOUS NEBULIZATION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 20, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 87.0, "maximum": 120.0, "gross_charge": 150.0, "discounted_cash": 90.0, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TPN NEONATAL-PEDIATRIC (SIMPLE)", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 422.65, "maximum": 582.96, "gross_charge": 728.7, "discounted_cash": 437.22, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 582.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 519.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 422.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 519.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 422.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "INSULIN LISPRO (U-100) INSULIN PUMP REFILL", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 1000, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 170.75, "maximum": 235.52, "gross_charge": 294.4, "discounted_cash": 176.64, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 170.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 209.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 170.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 235.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 209.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CUPRIC INTRAVENOUS SOLUTION (USE TPN CALCULATOR)", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 56.55, "maximum": 78.0, "gross_charge": 97.5, "discounted_cash": 58.5, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SODIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION (USE WITH TPN CALCULATOR)", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 100, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 21.87, "maximum": 30.16, "gross_charge": 37.7, "discounted_cash": 22.62, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION (USE WITH TPN CALCULATOR)", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 15, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 42.98, "maximum": 59.28, "gross_charge": 74.1, "discounted_cash": 44.46, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION (USE WITH TPN CALCULATOR)", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 33.76, "maximum": 46.56, "gross_charge": 58.2, "discounted_cash": 34.92, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "POTASSIUM PHOSPHATES-MBASIC AND DIBASIC 3 MMOL/ML INTRAVENOUS SOLUTION (USE WITH TPN CALCULATOR)", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 164.46, "maximum": 226.84, "gross_charge": 283.55, "discounted_cash": 170.13, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 226.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 202.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 164.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 202.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 164.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SODIUM CHLORIDE 4 MEQ/ML INTRAVENOUS SOLUTION (USE FOR TPN CALCULATOR)", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 100, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 43.15, "maximum": 59.52, "gross_charge": 74.4, "discounted_cash": 44.64, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MVI, PEDI NO.2 WITH VIT K 80 MG-400 UNIT-200 MCG INTRAVENOUS SOLUTION (USE WITH TPN CALCULATOR)", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 59.54, "maximum": 698.64, "gross_charge": 102.65, "discounted_cash": 61.59, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MVI, PEDI NO.2 WITH VIT K 80 MG-400 UNIT-200 MCG INTRAVENOUS SOLUTION (USE WITH TPN CALCULATOR)", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 59.54, "maximum": 698.64, "gross_charge": 873.3, "discounted_cash": 523.98, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 698.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 622.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 506.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 622.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 506.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MVI,ADULT NO.4 WITH VIT K 3300 UNIT-150 MCG/10 ML INTRAVENOUS SOLUTION (USE WITH TPN CALCULATOR)", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 8.76, "maximum": 12.08, "gross_charge": 15.1, "discounted_cash": 9.06, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CYSTEINE (L-CYSTEINE) 50 MG/ML INTRAVENOUS SOLUTION (USE WITH TPN CALCULATOR)", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 266.68, "maximum": 367.84, "gross_charge": 459.8, "discounted_cash": 275.88, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 367.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 327.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 266.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 327.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 266.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TRACE ELEMENTS CR-CU-MN-ZN 0.85 MCG-0.1 MG-25 MCG-1.5MG/ML INTRAVENOUS (USE WITH TPN CALCULATOR)", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 2, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 35.64, "maximum": 49.16, "gross_charge": 61.45, "discounted_cash": 36.87, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ZINC SULFATE 1 MG/ML INTRAVENOUS SOLUTION (USE WITH TPN CALCULATOR)", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 58.75, "maximum": 81.04, "gross_charge": 101.3, "discounted_cash": 60.78, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SODIUM PHOSPHATE 3 MMOL/ML ORAL SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 92.42, "maximum": 127.48, "gross_charge": 159.35, "discounted_cash": 95.61, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 113.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 113.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "BECLOMETHASONE IN CORN OIL 0.5 MG/ML (SIMPLE)", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 1000, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 30.45, "maximum": 42.0, "gross_charge": 52.5, "discounted_cash": 31.5, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SILICONE OIL KIT", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 402.4, "maximum": 555.04, "gross_charge": 693.8, "discounted_cash": 416.28, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 402.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 494.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 402.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 555.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 494.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PERFLUOROCARBON LIQUID", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 462.32, "maximum": 637.68, "gross_charge": 797.1, "discounted_cash": 478.26, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 637.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 568.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 462.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 568.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 462.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HISTIDINE-TRYPTOPHAN-KETOGLUTARATE (HTK) SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 1000, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 775.75, "maximum": 1070.0, "gross_charge": 1337.5, "discounted_cash": 802.5, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 775.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 953.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 775.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1070.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 953.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "IRON DEXTRAN 50 MG/ML INJECTION SOLUTION (USE WITH TPN CALCULATOR)", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 2, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 118.61, "maximum": 163.6, "gross_charge": 204.5, "discounted_cash": 122.7, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 118.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 163.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 145.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 145.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 118.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DEXMEDETOMIDINE INFUSION 4 MCG/ML (PEDIATRICS)", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 100, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 47.36, "maximum": 65.32, "gross_charge": 81.65, "discounted_cash": 48.99, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ETHACRYNIC ACID IV SYRINGE 1 MG/ML (PEDIATRICS)", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 15012.98, "maximum": 20707.56, "gross_charge": 25884.45, "discounted_cash": 15530.67, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 15012.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20707.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18455.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18455.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 15012.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SODIUM CHLORIDE 3% CONTINUOUS INFUSION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 500, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 7.25, "maximum": 10.0, "gross_charge": 12.5, "discounted_cash": 7.5, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SODIUM CHLORIDE 3% BOLUS", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 500, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 7.25, "maximum": 10.0, "gross_charge": 12.5, "discounted_cash": 7.5, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "INSULIN REGULAR 1 UNIT/ML INJECTION SYRINGE 50 ML (SIMPLE)", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.19, "maximum": 4.4, "gross_charge": 5.5, "discounted_cash": 3.3, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DESMOPRESSIN 10 MCG/ML BUCCAL ORAL SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 138.91, "maximum": 191.6, "gross_charge": 239.5, "discounted_cash": 143.7, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 170.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 138.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 138.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 191.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 170.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FENTANYL INFUSION/PCA 50 MCG/ML CASSETTE (PEDIATRICS)", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 53.13, "maximum": 73.28, "gross_charge": 91.6, "discounted_cash": 54.96, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SODIUM ACETATE IV SYRINGE 1 MEQ/ML", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 13.4, "maximum": 18.48, "gross_charge": 23.1, "discounted_cash": 13.86, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FAT EMULSION-SOYBEAN OIL-MCT-OLIVE OIL-FISH OIL 20% IVPB (PED TOXICOLOGY)", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 100, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 36.08, "maximum": 123.92, "gross_charge": 114.45, "discounted_cash": 68.67, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FAT EMULSION-SOYBEAN OIL-MCT-OLIVE OIL-FISH OIL 20% IVPB (PED TOXICOLOGY)", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 250, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 36.08, "maximum": 123.92, "gross_charge": 142.35, "discounted_cash": 85.41, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 113.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FAT EMULSION-SOYBEAN OIL-MCT-OLIVE OIL-FISH OIL 20% IVPB (PED TOXICOLOGY)", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 36.08, "maximum": 123.92, "gross_charge": 62.2, "discounted_cash": 37.32, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FAT EMULSION-SOYBEAN OIL-MCT-OLIVE OIL-FISH OIL 20% IVPB (PED TOXICOLOGY)", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 500, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 36.08, "maximum": 123.92, "gross_charge": 154.9, "discounted_cash": 92.94, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 123.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 110.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 110.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FAT EMULSION-SOYBEAN OIL-MCT-OLIVE OIL-FISH OIL 20% INTRAVENOUS (PED TOXICOLOGY)", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 500, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 106.95, "maximum": 147.52, "gross_charge": 184.4, "discounted_cash": 110.64, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 131.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 147.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 131.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "METHYLENE BLUE (ANTIDOTE) 0.5 % (5 MG/ML) INTRALESIONAL", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 167.07, "maximum": 230.44, "gross_charge": 288.05, "discounted_cash": 172.83, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 167.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 205.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 167.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 230.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 205.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ELECTROLYTE-A IV", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 1000, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 10.88, "maximum": 15.0, "gross_charge": 18.75, "discounted_cash": 11.25, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ANGIOTENSIN II INFUSION 10 MCG/ML (PEDIATRICS)", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 20, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 452.4, "maximum": 624.0, "gross_charge": 780.0, "discounted_cash": 468.0, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 452.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 556.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 452.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 624.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 556.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TRANEXAMIC ACID NEBULIZATION 100 MG/ML (PEDIATRICS)", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 2, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 2.0, "maximum": 2.76, "gross_charge": 3.45, "discounted_cash": 2.07, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SELENIUM 10 MCG/ML IN STERILE WATER INTRAVENOUS SOLUTION (USE TPN CALCULATOR)", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 668.04, "maximum": 921.44, "gross_charge": 1151.8, "discounted_cash": 691.08, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 668.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 821.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 668.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 921.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 821.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SODIUM BICARBONATE 1 MEQ/ML IV SOLUTION (PED AQUAPHERESIS)", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 32.28, "maximum": 44.52, "gross_charge": 55.65, "discounted_cash": 33.39, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DEHYDRATED ALCOHOL 20% IN STERILE WATER OPHTHALMIC SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 39.76, "maximum": 54.84, "gross_charge": 68.55, "discounted_cash": 41.13, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LIDOCAINE (PF) 40 MG/ML (4 %) OPHTHALMIC SOLUTION (INTRA-OP)", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 10.27, "maximum": 14.16, "gross_charge": 17.7, "discounted_cash": 10.62, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TRANEXAMIC ACID 100 MG/ML INFUSION OSM", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 7.98, "maximum": 11.0, "gross_charge": 13.75, "discounted_cash": 8.25, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FAT EMULSION-SOYBEAN OIL-MCT-OLIVE OIL-FISH OIL 20 % INTRAVENOUS (FOR TPN CALCULATOR)", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.77, "maximum": 129.8, "gross_charge": 12.95, "discounted_cash": 7.77, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FAT EMULSION-SOYBEAN OIL-MCT-OLIVE OIL-FISH OIL 20 % INTRAVENOUS (FOR TPN CALCULATOR)", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 100, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.77, "maximum": 129.8, "gross_charge": 119.4, "discounted_cash": 71.64, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 95.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FAT EMULSION-SOYBEAN OIL-MCT-OLIVE OIL-FISH OIL 20 % INTRAVENOUS (FOR TPN CALCULATOR)", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 15, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.77, "maximum": 129.8, "gross_charge": 19.45, "discounted_cash": 11.67, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FAT EMULSION-SOYBEAN OIL-MCT-OLIVE OIL-FISH OIL 20 % INTRAVENOUS (FOR TPN CALCULATOR)", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 20, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.77, "maximum": 129.8, "gross_charge": 25.9, "discounted_cash": 15.54, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FAT EMULSION-SOYBEAN OIL-MCT-OLIVE OIL-FISH OIL 20 % INTRAVENOUS (FOR TPN CALCULATOR)", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 25, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.77, "maximum": 129.8, "gross_charge": 32.35, "discounted_cash": 19.41, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FAT EMULSION-SOYBEAN OIL-MCT-OLIVE OIL-FISH OIL 20 % INTRAVENOUS (FOR TPN CALCULATOR)", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 250, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.77, "maximum": 129.8, "gross_charge": 148.5, "discounted_cash": 89.1, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 118.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FAT EMULSION-SOYBEAN OIL-MCT-OLIVE OIL-FISH OIL 20 % INTRAVENOUS (FOR TPN CALCULATOR)", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 30, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.77, "maximum": 129.8, "gross_charge": 38.85, "discounted_cash": 23.31, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FAT EMULSION-SOYBEAN OIL-MCT-OLIVE OIL-FISH OIL 20 % INTRAVENOUS (FOR TPN CALCULATOR)", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 35, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.77, "maximum": 129.8, "gross_charge": 45.3, "discounted_cash": 27.18, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FAT EMULSION-SOYBEAN OIL-MCT-OLIVE OIL-FISH OIL 20 % INTRAVENOUS (FOR TPN CALCULATOR)", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 40, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.77, "maximum": 129.8, "gross_charge": 51.75, "discounted_cash": 31.05, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FAT EMULSION-SOYBEAN OIL-MCT-OLIVE OIL-FISH OIL 20 % INTRAVENOUS (FOR TPN CALCULATOR)", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 45, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.77, "maximum": 129.8, "gross_charge": 58.25, "discounted_cash": 34.95, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FAT EMULSION-SOYBEAN OIL-MCT-OLIVE OIL-FISH OIL 20 % INTRAVENOUS (FOR TPN CALCULATOR)", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.77, "maximum": 129.8, "gross_charge": 6.5, "discounted_cash": 3.9, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FAT EMULSION-SOYBEAN OIL-MCT-OLIVE OIL-FISH OIL 20 % INTRAVENOUS (FOR TPN CALCULATOR)", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.77, "maximum": 129.8, "gross_charge": 64.7, "discounted_cash": 38.82, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FAT EMULSION-SOYBEAN OIL-MCT-OLIVE OIL-FISH OIL 20 % INTRAVENOUS (FOR TPN CALCULATOR)", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 500, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.77, "maximum": 129.8, "gross_charge": 162.25, "discounted_cash": 97.35, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 115.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 129.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 115.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DEXMEDETOMIDINE 100 MCG/ML ORAL LIQUID", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 2, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 6.7, "maximum": 9.24, "gross_charge": 11.55, "discounted_cash": 6.93, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "INSULIN SUBCUTANEOUS PUMP LISPRO (HUMALOG) 100 UNITS/ML WITH PED CALCULATOR", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 3, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 83.93, "maximum": 115.76, "gross_charge": 144.7, "discounted_cash": 86.82, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 115.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "INSULIN SUBCUTANEOUS PUMP GLULISINE (APIDRA) 100 UNITS/ML WITH PED CALCULATOR", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.26, "maximum": 0.36, "gross_charge": 0.45, "discounted_cash": 0.27, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "INSULIN SUBCUTANEOUS PUMP ASPART (NOVOLOG) 100 UNIT/ML WITH PED CALCULATOR", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.12, "maximum": 0.16, "gross_charge": 0.2, "discounted_cash": 0.12, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FAT EMULSION-SOYBEAN OIL-MCT-OLIVE OIL-FISH OIL 20 % INTRAVENOUS IVPB (PEDIATRICS)", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 100, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 69.25, "maximum": 129.8, "gross_charge": 119.4, "discounted_cash": 71.64, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 95.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FAT EMULSION-SOYBEAN OIL-MCT-OLIVE OIL-FISH OIL 20 % INTRAVENOUS IVPB (PEDIATRICS)", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 250, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 69.25, "maximum": 129.8, "gross_charge": 148.5, "discounted_cash": 89.1, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 118.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FAT EMULSION-SOYBEAN OIL-MCT-OLIVE OIL-FISH OIL 20 % INTRAVENOUS IVPB (PEDIATRICS)", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 500, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 69.25, "maximum": 129.8, "gross_charge": 162.25, "discounted_cash": 97.35, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 115.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 129.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 115.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "BIVALIRUDIN INFUSION 1 MG/ML (PEDIATRICS)", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 4.09, "maximum": 278.2, "gross_charge": 13.95, "discounted_cash": 8.37, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "BIVALIRUDIN INFUSION 1 MG/ML (PEDIATRICS)", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 20, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 4.09, "maximum": 278.2, "gross_charge": 28.1, "discounted_cash": 16.86, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "BIVALIRUDIN INFUSION 1 MG/ML (PEDIATRICS)", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 250, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 4.09, "maximum": 278.2, "gross_charge": 347.75, "discounted_cash": 208.65, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 247.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 201.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 278.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 247.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 201.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "BIVALIRUDIN INFUSION 1 MG/ML (PEDIATRICS)", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 30, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 4.09, "maximum": 278.2, "gross_charge": 41.75, "discounted_cash": 25.05, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "BIVALIRUDIN INFUSION 1 MG/ML (PEDIATRICS)", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 4.09, "maximum": 278.2, "gross_charge": 7.05, "discounted_cash": 4.23, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "BIVALIRUDIN INFUSION 1 MG/ML (PEDIATRICS)", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 4.09, "maximum": 278.2, "gross_charge": 69.55, "discounted_cash": 41.73, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "AEROGEN ALBUTEROL 2.5 MG/ML", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 40, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 188.5, "maximum": 260.0, "gross_charge": 325.0, "discounted_cash": 195.0, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 188.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 260.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 231.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 188.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 231.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "VANCOMYCIN 10 MG/ML INTRA-CATHETER SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.17, "maximum": 0.24, "gross_charge": 0.3, "discounted_cash": 0.18, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "INSULIN LISPRO (DILUTE) 10 UNIT/ML SUB-Q DOSE PEDIATRICS CALCULATOR", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 16.97, "maximum": 23.4, "gross_charge": 29.25, "discounted_cash": 17.55, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TRANEXAMIC ACID INFUSION 100 MG/ML (PEDIATRICS)", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 20, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 16.01, "maximum": 50.88, "gross_charge": 27.6, "discounted_cash": 16.56, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TRANEXAMIC ACID INFUSION 100 MG/ML (PEDIATRICS)", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 16.01, "maximum": 50.88, "gross_charge": 63.6, "discounted_cash": 38.16, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "BUMETANIDE INFUSION 0.04 MG/ML (PEDIATRICS)", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.74, "maximum": 2.4, "gross_charge": 3.0, "discounted_cash": 1.8, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "NOREPINEPHRINE INFUSION 16 MCG/ML IN NS (PEDIATRICS)", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.74, "maximum": 5.16, "gross_charge": 6.45, "discounted_cash": 3.87, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "NOREPINEPHRINE INFUSION 64 MCG/ML IN NS (PEDIATRICS)", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 8.32, "maximum": 11.48, "gross_charge": 14.35, "discounted_cash": 8.61, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "NOREPINEPHRINE INFUSION 32 MCG/ML IN NS (PEDIATRICS)", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 5.28, "maximum": 7.28, "gross_charge": 9.1, "discounted_cash": 5.46, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ENALAPRILAT IV SYRINGE 0.025 MG/ML (PEDIATRICS)", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 14.79, "maximum": 20.4, "gross_charge": 25.5, "discounted_cash": 15.3, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ANAKINRA 100 MG/0.67 ML IV SYRINGE (PEDIATRICS)", "code_information": [{"code": "2500003", "type": "CDM"}], "standard_charges": [{"setting": "outpatient", "minimum": 573.19, "maximum": 790.6, "gross_charge": 988.25, "discounted_cash": 592.95, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 704.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 573.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 790.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 704.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 573.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION (SO) (PEDIATRICS)", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 17.4, "maximum": 24.0, "gross_charge": 30.0, "discounted_cash": 18.0, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "KETAMINE 30 MG/3 ML (10 MG/ML) IN SODIUM CHLOR,ISO-OSMOTIC INJ SYRINGE (PEDIATRICS)", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 3, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 21.4, "maximum": 29.52, "gross_charge": 36.9, "discounted_cash": 22.14, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FAT EMULSION-SOYBEAN OIL-MCT-OLIVE OIL-FISH OIL 20 % INTRAVENOUS SYRINGE (PEDIATRICS)", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.77, "maximum": 51.76, "gross_charge": 12.95, "discounted_cash": 7.77, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FAT EMULSION-SOYBEAN OIL-MCT-OLIVE OIL-FISH OIL 20 % INTRAVENOUS SYRINGE (PEDIATRICS)", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 15, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.77, "maximum": 51.76, "gross_charge": 19.45, "discounted_cash": 11.67, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FAT EMULSION-SOYBEAN OIL-MCT-OLIVE OIL-FISH OIL 20 % INTRAVENOUS SYRINGE (PEDIATRICS)", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 20, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.77, "maximum": 51.76, "gross_charge": 25.9, "discounted_cash": 15.54, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FAT EMULSION-SOYBEAN OIL-MCT-OLIVE OIL-FISH OIL 20 % INTRAVENOUS SYRINGE (PEDIATRICS)", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 25, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.77, "maximum": 51.76, "gross_charge": 32.35, "discounted_cash": 19.41, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FAT EMULSION-SOYBEAN OIL-MCT-OLIVE OIL-FISH OIL 20 % INTRAVENOUS SYRINGE (PEDIATRICS)", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 30, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.77, "maximum": 51.76, "gross_charge": 38.85, "discounted_cash": 23.31, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FAT EMULSION-SOYBEAN OIL-MCT-OLIVE OIL-FISH OIL 20 % INTRAVENOUS SYRINGE (PEDIATRICS)", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 35, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.77, "maximum": 51.76, "gross_charge": 45.3, "discounted_cash": 27.18, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FAT EMULSION-SOYBEAN OIL-MCT-OLIVE OIL-FISH OIL 20 % INTRAVENOUS SYRINGE (PEDIATRICS)", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 40, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.77, "maximum": 51.76, "gross_charge": 51.75, "discounted_cash": 31.05, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FAT EMULSION-SOYBEAN OIL-MCT-OLIVE OIL-FISH OIL 20 % INTRAVENOUS SYRINGE (PEDIATRICS)", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 45, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.77, "maximum": 51.76, "gross_charge": 58.25, "discounted_cash": 34.95, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FAT EMULSION-SOYBEAN OIL-MCT-OLIVE OIL-FISH OIL 20 % INTRAVENOUS SYRINGE (PEDIATRICS)", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.77, "maximum": 51.76, "gross_charge": 6.5, "discounted_cash": 3.9, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FAT EMULSION-SOYBEAN OIL-MCT-OLIVE OIL-FISH OIL 20 % INTRAVENOUS SYRINGE (PEDIATRICS)", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.77, "maximum": 51.76, "gross_charge": 64.7, "discounted_cash": 38.82, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PHYSOSTIGMINE 0.4 MG/ML INTRAVENOUS SOLUTION (PEDIATRICS)", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 380.63, "maximum": 525.0, "gross_charge": 656.25, "discounted_cash": 393.75, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 525.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 467.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 380.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 467.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 380.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "POLYMYXIN B SULFATE 500,000 UNIT SOLUTION FOR INJECTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 12.09, "maximum": 16.68, "gross_charge": 20.85, "discounted_cash": 12.51, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 20, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 10.93, "maximum": 15.08, "gross_charge": 18.85, "discounted_cash": 11.31, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ASCORBIC ACID (VITAMIN C)(BULK) 100 % POWDER", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 500, "type": "GR"}, "standard_charges": [{"setting": "outpatient", "minimum": 53.94, "maximum": 74.4, "gross_charge": 93.0, "discounted_cash": 55.8, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SODIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 20, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 10.88, "maximum": 15.0, "gross_charge": 18.75, "discounted_cash": 11.25, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SODIUM CHLORIDE 3 % HYPERTONIC INTRAVENOUS INJECTION SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 500, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 7.25, "maximum": 10.0, "gross_charge": 12.5, "discounted_cash": 7.5, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SODIUM CHLORIDE 4 MEQ/ML INTRAVENOUS SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 100, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 43.15, "maximum": 59.52, "gross_charge": 74.4, "discounted_cash": 44.64, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SODIUM CHLORIDE (BULK) GRANULES", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 500, "type": "GR"}, "standard_charges": [{"setting": "outpatient", "minimum": 13.05, "maximum": 18.0, "gross_charge": 22.5, "discounted_cash": 13.5, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 15, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 42.98, "maximum": 59.28, "gross_charge": 74.1, "discounted_cash": 44.46, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SORBITOL 3 % IRRIGATION SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 3000, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 40.02, "maximum": 55.2, "gross_charge": 69.0, "discounted_cash": 41.4, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TANNIC ACID (BULK) POWDER", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 6, "type": "GR"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.9, "maximum": 1.24, "gross_charge": 1.55, "discounted_cash": 0.93, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SELENIUM 40 MCG/ML INTRAVENOUS SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 46.52, "maximum": 64.16, "gross_charge": 80.2, "discounted_cash": 48.12, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 2, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 29.84, "maximum": 41.16, "gross_charge": 51.45, "discounted_cash": 30.87, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TRYPAN BLUE 0.06 % INTRAOCULAR SYRINGE", "code_information": [{"code": "2500003", "type": "CDM"}], "standard_charges": [{"setting": "outpatient", "minimum": 243.92, "maximum": 336.44, "gross_charge": 420.55, "discounted_cash": 252.33, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 243.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 336.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 299.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 243.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 299.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ZINC CHLORIDE 1 MG/ML INTRAVENOUS SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 48.72, "maximum": 67.2, "gross_charge": 84.0, "discounted_cash": 50.4, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ZINC SULFATE 1 MG/ML INTRAVENOUS SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 58.75, "maximum": 81.04, "gross_charge": 101.3, "discounted_cash": 60.78, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "THROMBIN (RECOMBINANT) 5,000 UNIT TOPICAL SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 139.29, "maximum": 192.12, "gross_charge": 240.15, "discounted_cash": 144.09, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 171.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 139.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 192.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 171.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 139.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ACETIC ACID 0.25 % IRRIGATION SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 500, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 25.38, "maximum": 35.0, "gross_charge": 43.75, "discounted_cash": 26.25, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ALPROSTADIL 500 MCG/ML INJECTION SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 331.47, "maximum": 457.2, "gross_charge": 571.5, "discounted_cash": 342.9, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 407.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 331.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 457.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 407.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 331.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 250, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.32, "maximum": 35.0, "gross_charge": 43.75, "discounted_cash": 26.25, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 3, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.32, "maximum": 35.0, "gross_charge": 0.55, "discounted_cash": 0.33, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ARGININE HCL (L-ARGININE) 10 % INTRAVENOUS SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 300, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 122.5, "maximum": 168.96, "gross_charge": 211.2, "discounted_cash": 126.72, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 150.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 122.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 168.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 150.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 122.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "THROMBIN (RECOMBINANT) 20,000 UNIT TOPICAL SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 513.76, "maximum": 708.64, "gross_charge": 885.8, "discounted_cash": 531.48, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 513.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 708.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 631.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 513.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 631.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 6.64, "maximum": 9.16, "gross_charge": 11.45, "discounted_cash": 6.87, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "BUPIVACAINE-EPINEPHRINE 0.5 %-1:200,000 INJECTION SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 68.88, "maximum": 95.0, "gross_charge": 118.75, "discounted_cash": 71.25, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 95.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 5.77, "maximum": 7.96, "gross_charge": 9.95, "discounted_cash": 5.97, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DANTROLENE 20 MG INTRAVENOUS SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 165.5, "maximum": 228.28, "gross_charge": 285.35, "discounted_cash": 171.21, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 165.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 203.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 165.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 228.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 203.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 2, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 28.3, "maximum": 39.04, "gross_charge": 48.8, "discounted_cash": 29.28, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CITRA SELECT ORAL SUSPENSION", "code_information": [{"code": "2550001", "type": "CDM"}], "drug_information": {"unit": 450, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 6.88, "maximum": 30.24, "gross_charge": 37.8, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ELASTOMERIC PUMP RESERVOIR FOR MIXTURES RX SUPPLIED (400 ML)", "code_information": [{"code": "2700099", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 598.36, "maximum": 969.0, "gross_charge": 1211.25, "discounted_cash": 726.75, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 863.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 598.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 902.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 666.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 666.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 969.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 969.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 863.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 656.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 908.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 702.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 908.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 656.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 969.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 702.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DACARBAZINE IV SYRINGE 10 MG/ML (PEDIATRIC)", "code_information": [{"code": "6360005", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 12.77, "maximum": 56.12, "gross_charge": 70.15, "discounted_cash": 42.09, "payers_information": [{"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DACARBAZINE IVPB 10 MG/ML (PEDIATRIC)", "code_information": [{"code": "6360005", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 12.77, "maximum": 56.12, "gross_charge": 70.15, "discounted_cash": 42.09, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DOXORUBICIN 2 MG/ML IV SYRINGE", "code_information": [{"code": "6360005", "type": "CDM"}], "drug_information": {"unit": 25, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 39.31, "maximum": 172.8, "gross_charge": 216.0, "discounted_cash": 129.6, "payers_information": [{"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 172.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 125.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 125.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PHYTONADIONE (VITAMIN K1) 0.5 MG/ML INJECTION SOLUTION (USE TPN CALCULATOR)", "code_information": [{"code": "6360005", "type": "CDM"}], "drug_information": {"unit": 6, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 13.22, "maximum": 58.12, "gross_charge": 72.65, "discounted_cash": 43.59, "payers_information": [{"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MOXIFLOXACIN IV SYRINGE 1.6 MG/ML (PEDIATRICS)", "code_information": [{"code": "6360005", "type": "CDM"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 9.94, "maximum": 43.68, "gross_charge": 54.6, "discounted_cash": 32.76, "payers_information": [{"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CYCLOSPORINE IV SYRINGE 1 MG/ML (PEDIATRICS)", "code_information": [{"code": "6360005", "type": "CDM"}], "drug_information": {"unit": 250, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 42.51, "maximum": 186.84, "gross_charge": 233.55, "discounted_cash": 140.13, "payers_information": [{"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 135.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 186.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 135.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CYCLOSPORINE INFUSION SYRINGE 1 MG/ML (PEDIATRICS)", "code_information": [{"code": "6360005", "type": "CDM"}], "drug_information": {"unit": 250, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 42.51, "maximum": 186.84, "gross_charge": 233.55, "discounted_cash": 140.13, "payers_information": [{"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 186.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 135.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 135.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CYCLOSPORINE INFUSION IVPB 1 MG/ML (PEDIATRICS)", "code_information": [{"code": "6360005", "type": "CDM"}], "drug_information": {"unit": 250, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 42.51, "maximum": 186.84, "gross_charge": 233.55, "discounted_cash": 140.13, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 135.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 135.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 186.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CYCLOSPORINE IVPB 1 MG/ML (PEDIATRICS)", "code_information": [{"code": "6360005", "type": "CDM"}], "drug_information": {"unit": 250, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 42.51, "maximum": 186.84, "gross_charge": 233.55, "discounted_cash": 140.13, "payers_information": [{"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 186.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 135.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 135.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "EPOPROSTENOL NEBULIZATION SYRINGE 0.75 MCG/ML (VELETRI) (PEDIATRICS)", "code_information": [{"code": "6360005", "type": "CDM"}], "drug_information": {"unit": 20, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.49, "maximum": 6.48, "gross_charge": 2.7, "discounted_cash": 1.62, "payers_information": [{"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "EPOPROSTENOL NEBULIZATION SYRINGE 0.75 MCG/ML (VELETRI) (PEDIATRICS)", "code_information": [{"code": "6360005", "type": "CDM"}], "drug_information": {"unit": 40, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.49, "maximum": 6.48, "gross_charge": 5.4, "discounted_cash": 3.24, "payers_information": [{"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "EPOPROSTENOL NEBULIZATION SYRINGE 0.75 MCG/ML (VELETRI) (PEDIATRICS)", "code_information": [{"code": "6360005", "type": "CDM"}], "drug_information": {"unit": 60, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.49, "maximum": 6.48, "gross_charge": 8.1, "discounted_cash": 4.86, "payers_information": [{"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "EPOPROSTENOL NEBULIZATION SYRINGE 3 MCG/ML (VELETRI) (PEDIATRICS)", "code_information": [{"code": "6360005", "type": "CDM"}], "drug_information": {"unit": 20, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.95, "maximum": 25.6, "gross_charge": 10.7, "discounted_cash": 6.42, "payers_information": [{"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "EPOPROSTENOL NEBULIZATION SYRINGE 3 MCG/ML (VELETRI) (PEDIATRICS)", "code_information": [{"code": "6360005", "type": "CDM"}], "drug_information": {"unit": 40, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.95, "maximum": 25.6, "gross_charge": 21.35, "discounted_cash": 12.81, "payers_information": [{"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "EPOPROSTENOL NEBULIZATION SYRINGE 3 MCG/ML (VELETRI) (PEDIATRICS)", "code_information": [{"code": "6360005", "type": "CDM"}], "drug_information": {"unit": 60, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.95, "maximum": 25.6, "gross_charge": 32.0, "discounted_cash": 19.2, "payers_information": [{"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "EPOPROSTENOL NEBULIZATION SYRINGE 10 MCG/ML (VELETRI) (PEDIATRICS)", "code_information": [{"code": "6360005", "type": "CDM"}], "drug_information": {"unit": 20, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 6.49, "maximum": 85.56, "gross_charge": 35.65, "discounted_cash": 21.39, "payers_information": [{"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "EPOPROSTENOL NEBULIZATION SYRINGE 10 MCG/ML (VELETRI) (PEDIATRICS)", "code_information": [{"code": "6360005", "type": "CDM"}], "drug_information": {"unit": 40, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 6.49, "maximum": 85.56, "gross_charge": 71.3, "discounted_cash": 42.78, "payers_information": [{"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "EPOPROSTENOL NEBULIZATION SYRINGE 10 MCG/ML (VELETRI) (PEDIATRICS)", "code_information": [{"code": "6360005", "type": "CDM"}], "drug_information": {"unit": 60, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 6.49, "maximum": 85.56, "gross_charge": 106.95, "discounted_cash": 64.17, "payers_information": [{"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "EPOPROSTENOL NEBULIZATION SYRINGE 20 MCG/ML (VELETRI) (PEDIATRICS)", "code_information": [{"code": "6360005", "type": "CDM"}], "drug_information": {"unit": 20, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 13.0, "maximum": 171.4, "gross_charge": 71.45, "discounted_cash": 42.87, "payers_information": [{"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "EPOPROSTENOL NEBULIZATION SYRINGE 20 MCG/ML (VELETRI) (PEDIATRICS)", "code_information": [{"code": "6360005", "type": "CDM"}], "drug_information": {"unit": 40, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 13.0, "maximum": 171.4, "gross_charge": 142.85, "discounted_cash": 85.71, "payers_information": [{"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "EPOPROSTENOL NEBULIZATION SYRINGE 20 MCG/ML (VELETRI) (PEDIATRICS)", "code_information": [{"code": "6360005", "type": "CDM"}], "drug_information": {"unit": 60, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 13.0, "maximum": 171.4, "gross_charge": 214.25, "discounted_cash": 128.55, "payers_information": [{"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 124.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 171.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 124.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SOTALOL IV SYRINGE 1.5 MG/ML (PEDIATRICS)", "code_information": [{"code": "6360005", "type": "CDM"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 1649.65, "maximum": 7251.2, "gross_charge": 9064.0, "discounted_cash": 5438.4, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 5257.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2120.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7251.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1867.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1649.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2120.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 5257.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2120.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2120.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DESMOPRESSIN 1 MCG/ML SUBCUTANEOUS INJECTION (PEDIATRICS)", "code_information": [{"code": "6360005", "type": "CDM"}], "drug_information": {"unit": 4, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 21.98, "maximum": 96.6, "gross_charge": 120.75, "discounted_cash": 72.45, "payers_information": [{"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 96.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 7.08, "maximum": 9.76, "gross_charge": 12.2, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FELBAMATE 400 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 8.06, "maximum": 11.12, "gross_charge": 13.9, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FELBAMATE 600 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 2.93, "maximum": 4.04, "gross_charge": 5.05, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FLECAINIDE 100 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.33, "maximum": 1.84, "gross_charge": 2.3, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FLUCONAZOLE 100 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 2.84, "maximum": 3.92, "gross_charge": 4.9, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FLUCONAZOLE 50 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.93, "maximum": 1.28, "gross_charge": 1.6, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FLUCYTOSINE 250 MG CAPSULE", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 43.85, "maximum": 60.48, "gross_charge": 75.6, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FLUDROCORTISONE 0.1 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.78, "maximum": 1.08, "gross_charge": 1.35, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DICLOFENAC 1 % TOPICAL GEL", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 100, "type": "GR"}, "standard_charges": [{"setting": "outpatient", "minimum": 9.31, "maximum": 12.84, "gross_charge": 16.05, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FLUVOXAMINE 100 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.52, "maximum": 0.72, "gross_charge": 0.9, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "GUANFACINE 1 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.44, "maximum": 0.6, "gross_charge": 0.75, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HYDROCORTISONE 5 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.38, "maximum": 0.52, "gross_charge": 0.65, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HYDROCORTISONE 100 MG/60 ML ENEMA", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 60, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 39.85, "maximum": 54.96, "gross_charge": 68.7, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HYDROXYCHLOROQUINE 200 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 2.12, "maximum": 2.92, "gross_charge": 3.65, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HYDROXYUREA 500 MG CAPSULE", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.62, "maximum": 2.24, "gross_charge": 2.8, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ISRADIPINE 2.5 MG CAPSULE", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.07, "maximum": 4.24, "gross_charge": 5.3, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ITRACONAZOLE 100 MG CAPSULE", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 5.95, "maximum": 8.2, "gross_charge": 10.25, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LABETALOL 200 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.99, "maximum": 1.36, "gross_charge": 1.7, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LAMOTRIGINE 25 MG CHEWABLE DISPERSIBLE TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.96, "maximum": 1.32, "gross_charge": 1.65, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TAMSULOSIN 0.4 MG CAPSULE", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.44, "maximum": 0.6, "gross_charge": 0.75, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LEVONORGESTREL 0.15 MG-ETHINYL ESTRADIOL 0.03 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.41, "maximum": 0.56, "gross_charge": 0.7, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LEVOTHYROXINE 88 MCG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.87, "maximum": 1.2, "gross_charge": 1.5, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LIOTHYRONINE 5 MCG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.19, "maximum": 1.64, "gross_charge": 2.05, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LISINOPRIL 5 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.23, "maximum": 0.32, "gross_charge": 0.4, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.81, "maximum": 1.12, "gross_charge": 1.4, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.16, "maximum": 1.6, "gross_charge": 2.0, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 74.56, "maximum": 102.84, "gross_charge": 128.55, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FLUTICASONE 250 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 87.61, "maximum": 120.84, "gross_charge": 151.05, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 107.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 107.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FLUTICASONE 500 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 114.12, "maximum": 157.4, "gross_charge": 196.75, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 157.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 140.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 140.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LAMOTRIGINE 5 MG CHEWABLE DISPERSIBLE TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.49, "maximum": 0.68, "gross_charge": 0.85, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TRANEXAMIC ACID 650 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 6.26, "maximum": 8.64, "gross_charge": 10.8, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LOMUSTINE 10 MG CAPSULE", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 204.02, "maximum": 281.4, "gross_charge": 351.75, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 204.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 250.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 281.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 250.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 204.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "RIFAXIMIN 550 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 96.92, "maximum": 133.68, "gross_charge": 167.1, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 96.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 133.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 119.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 119.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 96.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LOMUSTINE 40 MG CAPSULE", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 679.96, "maximum": 937.88, "gross_charge": 1172.35, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 679.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 835.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 937.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 835.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 679.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MAFENIDE 85 MG/G TOPICAL CREAM", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 56, "type": "GR"}, "standard_charges": [{"setting": "outpatient", "minimum": 54.46, "maximum": 75.12, "gross_charge": 93.9, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MERCAPTOPURINE 50 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 4.76, "maximum": 6.56, "gross_charge": 8.2, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MESALAMINE ER 250 MG CAPSULE,EXTENDED RELEASE", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 6.47, "maximum": 8.92, "gross_charge": 11.15, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "METFORMIN 500 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.15, "maximum": 0.2, "gross_charge": 0.25, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "METHIMAZOLE 5 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.07, "maximum": 1.48, "gross_charge": 1.85, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "METHSUXIMIDE 300 MG CAPSULE", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 9.74, "maximum": 13.44, "gross_charge": 16.8, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MOMETASONE-FORMOTEROL HFA 100 MCG-5 MCG/ACTUATION AEROSOL INHALER", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 8, "type": "GR"}, "standard_charges": [{"setting": "outpatient", "minimum": 184.47, "maximum": 254.44, "gross_charge": 318.05, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 184.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 254.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 226.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 226.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 184.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MOMETASONE-FORMOTEROL HFA 200 MCG-5 MCG/ACTUATION AEROSOL INHALER", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 8, "type": "GR"}, "standard_charges": [{"setting": "outpatient", "minimum": 184.47, "maximum": 254.44, "gross_charge": 318.05, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 184.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 226.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 254.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 226.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 184.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "METOLAZONE 5 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 4.96, "maximum": 6.84, "gross_charge": 8.55, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "METYROSINE 250 MG CAPSULE", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 290.32, "maximum": 400.44, "gross_charge": 500.55, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 290.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 356.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 400.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 356.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 290.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MEXILETINE 150 MG CAPSULE", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.75, "maximum": 1.04, "gross_charge": 1.3, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ULIPRISTAL 30 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 71.95, "maximum": 99.24, "gross_charge": 124.05, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 88.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 88.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MIDODRINE 2.5 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.31, "maximum": 1.8, "gross_charge": 2.25, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "BUPRENORPHINE 2 MG-NALOXONE 0.5 MG SUBLINGUAL FILM", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 5.34, "maximum": 7.36, "gross_charge": 9.2, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "BUPRENORPHINE 8 MG-NALOXONE 2 MG SUBLINGUAL FILM", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 9.54, "maximum": 13.16, "gross_charge": 16.45, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 3, "type": "GR"}, "standard_charges": [{"setting": "outpatient", "minimum": 6.67, "maximum": 9.2, "gross_charge": 11.5, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MISOPROSTOL 200 MCG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 2.32, "maximum": 3.2, "gross_charge": 4.0, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MUPIROCIN 2 % TOPICAL OINTMENT", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 22, "type": "GR"}, "standard_charges": [{"setting": "outpatient", "minimum": 2.78, "maximum": 3.84, "gross_charge": 4.8, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "NALTREXONE 50 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 5.54, "maximum": 7.64, "gross_charge": 9.55, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 11.46, "maximum": 15.8, "gross_charge": 19.75, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "NIMODIPINE 30 MG CAPSULE", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 4.9, "maximum": 6.76, "gross_charge": 8.45, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "NORETHINDRONE ACETATE 5 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.28, "maximum": 1.76, "gross_charge": 2.2, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "BUPRENORPHINE 20 MCG/HOUR WEEKLY TRANSDERMAL PATCH", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 184.41, "maximum": 254.36, "gross_charge": 317.95, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 184.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 254.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 226.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 226.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 184.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CLONIDINE HCL ER 0.1 MG TABLET,EXTENDED RELEASE,12 HR", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 9.22, "maximum": 12.72, "gross_charge": 15.9, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OXYCODONE 5 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.73, "maximum": 1.0, "gross_charge": 1.25, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DASATINIB 80 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 851.06, "maximum": 1173.88, "gross_charge": 1467.35, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 851.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1046.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1173.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1046.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 851.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DASATINIB 140 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 851.06, "maximum": 1173.88, "gross_charge": 1467.35, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 851.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1173.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1046.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1046.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 851.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PAROXETINE 20 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.41, "maximum": 0.56, "gross_charge": 0.7, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PERMETHRIN 5 % TOPICAL CREAM", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 60, "type": "GR"}, "standard_charges": [{"setting": "outpatient", "minimum": 23.87, "maximum": 32.92, "gross_charge": 41.15, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PHENOXYBENZAMINE 10 MG CAPSULE", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 50.29, "maximum": 69.36, "gross_charge": 86.7, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PHENYTOIN 50 MG CHEWABLE TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.36, "maximum": 4.64, "gross_charge": 5.8, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PHYTONADIONE (VITAMIN K1) 5 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 84.27, "maximum": 116.24, "gross_charge": 145.3, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 116.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "RIVAROXABAN 10 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 27.78, "maximum": 38.32, "gross_charge": 47.9, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FIDAXOMICIN 200 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 298.15, "maximum": 411.24, "gross_charge": 514.05, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 298.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 298.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 366.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 411.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 366.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SODIUM DI- AND MONOPHOSPHATE-POTASSIUM PHOS MONOBASIC 250 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.58, "maximum": 0.8, "gross_charge": 1.0, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "POTASSIUM CITRATE ER 10 MEQ (1,080 MG) TABLET,EXTENDED RELEASE", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 4.47, "maximum": 6.16, "gross_charge": 7.7, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "POTASSIUM PHOSPHATE, MONOBASIC 500 MG (3.6 MMOL OF PHOSPHORUS) ORAL TBSO", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.07, "maximum": 1.48, "gross_charge": 1.85, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PRAVASTATIN 10 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.67, "maximum": 0.92, "gross_charge": 1.15, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LIPASE-PROTEASE-AMYLASE (PORK) 3,000-9,500-15,000 UNIT CAPSULE,DEL REL", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 269.27, "maximum": 371.4, "gross_charge": 464.25, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 269.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 371.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 331.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 331.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 269.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PROCHLORPERAZINE 25 MG RECTAL SUPPOSITORY", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 17.98, "maximum": 24.8, "gross_charge": 31.0, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PROMETHAZINE 25 MG RECTAL SUPPOSITORY", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 12.27, "maximum": 16.92, "gross_charge": 21.15, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ACETAZOLAMIDE 125 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.58, "maximum": 0.8, "gross_charge": 1.0, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PYRIDOSTIGMINE BROMIDE 60 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.91, "maximum": 2.64, "gross_charge": 3.3, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CLOBAZAM 10 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 5.45, "maximum": 7.52, "gross_charge": 9.4, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "RIBAVIRIN 200 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.48, "maximum": 2.04, "gross_charge": 2.55, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "RIFAMPIN 150 MG CAPSULE", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 5.37, "maximum": 7.4, "gross_charge": 9.25, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "RIFAMPIN 300 MG CAPSULE", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.31, "maximum": 4.56, "gross_charge": 5.7, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "RUXOLITINIB 5 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 414.47, "maximum": 571.68, "gross_charge": 714.6, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 414.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 414.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 509.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 571.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 509.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ACETAZOLAMIDE 250 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 4.0, "maximum": 5.52, "gross_charge": 6.9, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 4.26, "maximum": 5.88, "gross_charge": 7.35, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SALICYLIC ACID-SULFUR 2 %-2 % SHAMPOO", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 118, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.65, "maximum": 2.28, "gross_charge": 2.85, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SERTRALINE 100 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.67, "maximum": 0.92, "gross_charge": 1.15, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SERTRALINE 50 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.61, "maximum": 0.84, "gross_charge": 1.05, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LURASIDONE 20 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 5.66, "maximum": 7.8, "gross_charge": 9.75, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.61, "maximum": 0.84, "gross_charge": 1.05, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SOTALOL 80 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 2.03, "maximum": 2.8, "gross_charge": 3.5, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SUCCIMER 100 MG CAPSULE", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 44.75, "maximum": 61.72, "gross_charge": 77.15, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SUCRALFATE 1 GRAM TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.67, "maximum": 0.92, "gross_charge": 1.15, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TEMAZEPAM 7.5 MG CAPSULE", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 16.7, "maximum": 23.04, "gross_charge": 28.8, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TERBUTALINE 2.5 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 2.18, "maximum": 3.0, "gross_charge": 3.75, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TIMOLOL MALEATE 0.25 % EYE DROPS", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 2.38, "maximum": 3.28, "gross_charge": 4.1, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TIMOLOL MALEATE 0.5 % EYE DROPS", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 6.29, "maximum": 8.68, "gross_charge": 10.85, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TOBRAMYCIN-DEXAMETHASONE 0.3 %-0.1 % EYE OINTMENT", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 3, "type": "GR"}, "standard_charges": [{"setting": "outpatient", "minimum": 207.52, "maximum": 286.24, "gross_charge": 357.8, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 207.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 286.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 255.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 255.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 207.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TOBRAMYCIN 0.3 %-DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 80.68, "maximum": 111.28, "gross_charge": 139.1, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 111.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "POLYMYXIN B SULFATE 10,000 UNIT-TRIMETHOPRIM 1 MG/ML EYE DROPS", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 8.27, "maximum": 11.4, "gross_charge": 14.25, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "RALTEGRAVIR 25 MG CHEWABLE TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 4.87, "maximum": 6.72, "gross_charge": 8.4, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "RALTEGRAVIR 100 MG CHEWABLE TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 19.46, "maximum": 26.84, "gross_charge": 33.55, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LIPASE-PROTEASE-AMYLASE (PORCINE) 10,440-39,150-39,150 UNIT TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 896.45, "maximum": 1236.48, "gross_charge": 1545.6, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 896.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 896.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1102.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1236.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1102.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "URSODIOL 300 MG CAPSULE", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 6.15, "maximum": 8.48, "gross_charge": 10.6, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "VANCOMYCIN 125 MG CAPSULE", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 2.78, "maximum": 3.84, "gross_charge": 4.8, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LIPASE-PROTEASE-AMYLASE 16,000-57,500-60,500 UNIT CAPSULE,DELAYED REL", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1152.34, "maximum": 1589.44, "gross_charge": 1986.8, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1589.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1416.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1416.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1152.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1152.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ZOLPIDEM 5 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.23, "maximum": 0.32, "gross_charge": 0.4, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MORPHINE ER 30 MG TABLET,EXTENDED RELEASE", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.02, "maximum": 4.16, "gross_charge": 5.2, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "BUPRENORPHINE 4 MG-NALOXONE 1 MG SUBLINGUAL FILM", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 9.86, "maximum": 13.6, "gross_charge": 17.0, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OXCARBAZEPINE ER 150 MG TABLET,EXTENDED RELEASE 24 HR", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 20.33, "maximum": 28.04, "gross_charge": 35.05, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OXCARBAZEPINE ER 600 MG TABLET,EXTENDED RELEASE 24 HR", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 45.21, "maximum": 62.36, "gross_charge": 77.95, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TOFACITINIB 5 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 169.97, "maximum": 234.44, "gross_charge": 293.05, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 234.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 208.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 208.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 169.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 169.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MORPHINE ER 15 MG TABLET,EXTENDED RELEASE", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.57, "maximum": 2.16, "gross_charge": 2.7, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PONATINIB 15 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1090.92, "maximum": 1504.72, "gross_charge": 1880.9, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1504.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1341.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1341.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1090.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1090.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PONATINIB 45 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1090.92, "maximum": 1504.72, "gross_charge": 1880.9, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1090.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1090.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1341.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1504.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1341.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "GLYCEROL PHENYLBUTYRATE 1.1 GRAM/ML ORAL LIQUID", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 25, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 10498.73, "maximum": 14481.0, "gross_charge": 18101.25, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14481.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12906.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12906.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 10498.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 10498.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CEFIXIME 400 MG CAPSULE", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 22.3, "maximum": 30.76, "gross_charge": 38.45, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DEXTROAMPHETAMINE-AMPHETAMINE 10 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.22, "maximum": 1.68, "gross_charge": 2.1, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "VENLAFAXINE 25 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 2.0, "maximum": 2.76, "gross_charge": 3.45, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 11.4, "maximum": 15.72, "gross_charge": 19.65, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OXYCODONE ER 15 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 16.76, "maximum": 23.12, "gross_charge": 28.9, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DOLUTEGRAVIR 50 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 130.15, "maximum": 179.52, "gross_charge": 224.4, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 179.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 160.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 160.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 130.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 130.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LURASIDONE 60 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.87, "maximum": 1.2, "gross_charge": 1.5, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PERAMPANEL 2 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 43.94, "maximum": 60.6, "gross_charge": 75.75, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PERAMPANEL 4 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 75.92, "maximum": 104.72, "gross_charge": 130.9, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "RIOCIGUAT 0.5 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.31, "maximum": 4.56, "gross_charge": 5.7, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "RIOCIGUAT 1 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 267.47, "maximum": 368.92, "gross_charge": 461.15, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 267.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 328.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 368.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 328.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 267.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.07, "maximum": 1.48, "gross_charge": 1.85, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "POSACONAZOLE 100 MG TABLET,DELAYED RELEASE", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 38.54, "maximum": 53.16, "gross_charge": 66.45, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ACTIVATED CHARCOAL 50 GRAM/240 ML ORAL SUSPENSION", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 240, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 35.09, "maximum": 48.4, "gross_charge": 60.5, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MERCAPTOPURINE 20 MG/ML ORAL SUSPENSION", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 100, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 1421.29, "maximum": 1960.4, "gross_charge": 2450.5, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1421.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1747.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1960.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1747.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1421.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "RALTEGRAVIR 100 MG POWDER PACKET FOR ORAL SUSPENSION", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 19.46, "maximum": 26.84, "gross_charge": 33.55, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "EMPAGLIFLOZIN 10 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 21.23, "maximum": 29.28, "gross_charge": 36.6, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TIOTROPIUM BROMIDE 2.5 MCG/ACTUATION MIST FOR INHALATION", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 4, "type": "GR"}, "standard_charges": [{"setting": "outpatient", "minimum": 27.87, "maximum": 38.44, "gross_charge": 48.05, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MOMETASONE 100 MCG/ACTUATION HFA AEROSOL INHALER", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 13, "type": "GR"}, "standard_charges": [{"setting": "outpatient", "minimum": 78.27, "maximum": 107.96, "gross_charge": 134.95, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 96.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 107.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 96.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MOMETASONE 200 MCG/ACTUATION HFA AEROSOL INHALER", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 13, "type": "GR"}, "standard_charges": [{"setting": "outpatient", "minimum": 91.99, "maximum": 126.88, "gross_charge": 158.6, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 126.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 113.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 113.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LISDEXAMFETAMINE 10 MG CAPSULE", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 27.43, "maximum": 37.84, "gross_charge": 47.3, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 21.0, "maximum": 28.96, "gross_charge": 36.2, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ISAVUCONAZONIUM SULFATE 186 MG CAPSULE", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 165.76, "maximum": 228.64, "gross_charge": 285.8, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 165.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 165.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 203.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 228.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 203.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DEFERASIROX 180 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 2.15, "maximum": 2.96, "gross_charge": 3.7, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DEFERASIROX 360 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 8.35, "maximum": 11.52, "gross_charge": 14.4, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "IVABRADINE 5 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 24.91, "maximum": 34.36, "gross_charge": 42.95, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "IVABRADINE 7.5 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 24.91, "maximum": 34.36, "gross_charge": 42.95, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 100, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 134.5, "maximum": 319.68, "gross_charge": 399.6, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 319.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 284.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 284.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 231.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 231.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 134.5, "maximum": 319.68, "gross_charge": 231.9, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 185.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 165.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 165.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 134.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 134.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 6, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 8.06, "maximum": 11.12, "gross_charge": 13.9, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "COMPOUNDING VEHICLE SUSPENSION NO.11 ORAL", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 473, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 25.26, "maximum": 34.84, "gross_charge": 43.55, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MIDAZOLAM 10 MG/5 ML (2 MG/ML) ORAL SYRUP", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 12.96, "maximum": 17.88, "gross_charge": 22.35, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "INFANT FORMULA-IRON-DHA-ARA 2.3 GRAM-5.3 GRAM/100 KCAL ORAL POWDER", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 352, "type": "GR"}, "standard_charges": [{"setting": "outpatient", "minimum": 47.18, "maximum": 65.08, "gross_charge": 81.35, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "VERAPAMIL ER (SR) 240 MG TABLET,EXTENDED RELEASE", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.49, "maximum": 0.68, "gross_charge": 0.85, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "VALACYCLOVIR 500 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 2.84, "maximum": 3.92, "gross_charge": 4.9, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TRICHLOROACETIC ACID 50 % TOPICAL POWDER FOR SOLUTION", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 12, "type": "GR"}, "standard_charges": [{"setting": "outpatient", "minimum": 18.33, "maximum": 25.28, "gross_charge": 31.6, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "INFANT FORMULA-IRON-DHA-ARA 2 GRAM-5.3 GRAM/100 KCAL ORAL POWDER", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 354, "type": "GR"}, "standard_charges": [{"setting": "outpatient", "minimum": 42.43, "maximum": 58.52, "gross_charge": 73.15, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CARBAMAZEPINE 100 MG CHEWABLE TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.84, "maximum": 1.16, "gross_charge": 1.45, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CARBAMAZEPINE 200 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 6.55, "maximum": 9.04, "gross_charge": 11.3, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LAMOTRIGINE 25 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.35, "maximum": 0.48, "gross_charge": 0.6, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LAMOTRIGINE 100 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.38, "maximum": 0.52, "gross_charge": 0.65, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FLUCONAZOLE 40 MG/ML ORAL SUSPENSION", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 35, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 74.27, "maximum": 102.44, "gross_charge": 128.05, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DORZOLAMIDE 2 % EYE DROPS", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 27.06, "maximum": 37.32, "gross_charge": 46.65, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.38, "maximum": 0.52, "gross_charge": 0.65, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TIZANIDINE 2 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.31, "maximum": 1.8, "gross_charge": 2.25, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LOSARTAN 25 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.73, "maximum": 1.0, "gross_charge": 1.25, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SUMATRIPTAN 25 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.73, "maximum": 1.0, "gross_charge": 1.25, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "METHYLPHENIDATE ER 20 MG TABLET,EXTENDED RELEASE", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.51, "maximum": 2.08, "gross_charge": 2.6, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SOTALOL 120 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.46, "maximum": 0.64, "gross_charge": 0.8, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CARVEDILOL 25 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.17, "maximum": 0.24, "gross_charge": 0.3, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TRETINOIN (ANTINEOPLASTIC) 10 MG CAPSULE", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 45.15, "maximum": 62.28, "gross_charge": 77.85, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DESMOPRESSIN 0.1 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.65, "maximum": 2.28, "gross_charge": 2.85, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DESMOPRESSIN 0.2 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 4.41, "maximum": 6.08, "gross_charge": 7.6, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CALCITRIOL 1 MCG/ML ORAL SOLUTION", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 15, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 123.98, "maximum": 171.0, "gross_charge": 213.75, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 123.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 123.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 152.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 171.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 152.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 2.2, "maximum": 3.04, "gross_charge": 3.8, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SACUBITRIL 49 MG-VALSARTAN 51 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 2.2, "maximum": 3.04, "gross_charge": 3.8, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SACUBITRIL 97 MG-VALSARTAN 103 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 2.2, "maximum": 3.04, "gross_charge": 3.8, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SELENIUM SULFIDE 2.5 % LOTION", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 120, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 7.11, "maximum": 9.8, "gross_charge": 12.25, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "NALOXONE 4 MG/ACTUATION NASAL SPRAY", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 2, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 83.87, "maximum": 115.68, "gross_charge": 144.6, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 115.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SELEXIPAG 200 MCG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 313.37, "maximum": 432.24, "gross_charge": 540.3, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 313.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 385.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 432.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 385.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 313.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SELEXIPAG 800 MCG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 487.35, "maximum": 672.2, "gross_charge": 840.25, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 487.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 672.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 599.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 599.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 487.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "BRIVARACETAM 25 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 45.59, "maximum": 62.88, "gross_charge": 78.6, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "BRIVARACETAM 100 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 45.59, "maximum": 62.88, "gross_charge": 78.6, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TADALAFIL 20 MG TABLET (PULMONARY HYPERTENSION)", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.77, "maximum": 2.44, "gross_charge": 3.05, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "EMTRICITABINE 100 MG-TENOFOVIR DISOPROXIL FUMARATE 150 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 24.77, "maximum": 34.16, "gross_charge": 42.7, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "EMTRICITABINE 133 MG-TENOFOVIR DISOPROXIL FUMARATE 200 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 103.12, "maximum": 142.24, "gross_charge": 177.8, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 126.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 142.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 126.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "EMTRICITABINE 167 MG-TENOFOVIR DISOPROXIL FUMARATE 250 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 26.01, "maximum": 35.88, "gross_charge": 44.85, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LISINOPRIL 1 MG/ML ORAL SOLUTION", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 150, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 724.19, "maximum": 998.88, "gross_charge": 1248.6, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 724.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 890.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 998.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 890.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 724.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CLINDAMYCIN HCL 150 MG CAPSULE", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.44, "maximum": 0.6, "gross_charge": 0.75, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CLINDAMYCIN HCL 75 MG CAPSULE", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.49, "maximum": 0.68, "gross_charge": 0.85, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CLINDAMYCIN PHOSPHATE 1 % TOPICAL SOLUTION", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 30, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 4.38, "maximum": 6.04, "gross_charge": 7.55, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MIRTAZAPINE 15 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.32, "maximum": 0.44, "gross_charge": 0.55, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "AZITHROMYCIN 500 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.71, "maximum": 2.36, "gross_charge": 2.95, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CLONIDINE HCL 0.1 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.52, "maximum": 0.72, "gross_charge": 0.9, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CLONIDINE HCL 0.2 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.58, "maximum": 0.8, "gross_charge": 1.0, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CLORAZEPATE DIPOTASSIUM 3.75 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 2.38, "maximum": 3.28, "gross_charge": 4.1, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SODIUM PHENYLBUTYRATE 0.94 GRAM/GRAM ORAL POWDER", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 266, "type": "GR"}, "standard_charges": [{"setting": "outpatient", "minimum": 4468.58, "maximum": 6163.56, "gross_charge": 7704.45, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6163.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5493.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5493.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4468.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4468.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CLOTRIMAZOLE 1 % TOPICAL CREAM", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 15, "type": "GR"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.13, "maximum": 4.32, "gross_charge": 5.4, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CLOTRIMAZOLE 1 % VAGINAL CREAM", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 45, "type": "GR"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.22, "maximum": 4.44, "gross_charge": 5.55, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OLANZAPINE 5 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.64, "maximum": 0.88, "gross_charge": 1.1, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "COLCHICINE 0.6 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 6.24, "maximum": 8.6, "gross_charge": 10.75, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "GABAPENTIN 300 MG CAPSULE", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.26, "maximum": 0.36, "gross_charge": 0.45, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "GABAPENTIN 100 MG CAPSULE", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.23, "maximum": 0.32, "gross_charge": 0.4, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "RISPERIDONE 2 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.38, "maximum": 0.52, "gross_charge": 0.65, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "THEOPHYLLINE ER 400 MG TABLET,EXTENDED RELEASE 24 HR", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 2.84, "maximum": 3.92, "gross_charge": 4.9, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CARVEDILOL 3.125 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.2, "maximum": 0.28, "gross_charge": 0.35, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LATANOPROST 0.005 % EYE DROPS", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 2, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 2.87, "maximum": 3.96, "gross_charge": 4.95, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LEVOFLOXACIN 250 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.49, "maximum": 0.68, "gross_charge": 0.85, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TOPIRAMATE 100 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.93, "maximum": 1.28, "gross_charge": 1.6, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LETERMOVIR 480 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 318.3, "maximum": 439.04, "gross_charge": 548.8, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 318.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 391.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 439.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 391.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 318.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LETERMOVIR 480 MG/24 ML INTRAVENOUS SOLUTION", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 12, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 495.18, "maximum": 683.0, "gross_charge": 853.75, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 495.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 683.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 608.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 608.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 495.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LIPASE-PROTEASE-AMYLASE (PORK) 20,000-63,000-84K UNIT CAPSULE, DEL REL", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1750.9, "maximum": 2415.04, "gross_charge": 3018.8, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1750.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2152.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2415.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2152.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1750.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "GLUTAMINE (SICKLE CELL) 5 GRAM ORAL POWDER PACKET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 47.47, "maximum": 65.48, "gross_charge": 81.85, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "BICTEGRAVIR 50 MG-EMTRICITABINE 200 MG-TENOFOVIR ALAFENAM 25 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 196.65, "maximum": 271.24, "gross_charge": 339.05, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 196.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 196.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 241.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 271.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 241.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 451.47, "maximum": 622.72, "gross_charge": 778.4, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 622.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 555.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 555.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 451.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 451.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LIPASE-PROTEASE-AMYLASE 25,000-79,000-105,000 UNIT CAPSULE,DELAYED REL", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 2166.65, "maximum": 2988.48, "gross_charge": 3735.6, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2166.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2166.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2663.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2988.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2663.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 54.9, "maximum": 75.72, "gross_charge": 94.65, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LIPASE-PROTEASE-AMYLASE 10,000-32,000-42,000 UNIT CAPSULE,DELAYED REL", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 892.5, "maximum": 1231.04, "gross_charge": 1538.8, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 892.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 892.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1097.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1231.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1097.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LIPASE-PROTEASE-AMYLASE 15,000-47,000-63,000 UNIT CAPSULE,DELAYED REL", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1288.99, "maximum": 1777.92, "gross_charge": 2222.4, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1288.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1777.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1584.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1584.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1288.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DIAZOXIDE 50 MG/ML ORAL SUSPENSION", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 30, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 490.33, "maximum": 676.32, "gross_charge": 845.4, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 490.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 602.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 676.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 602.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 490.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "KETOROLAC 0.5 % EYE DROPS", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 5.25, "maximum": 7.24, "gross_charge": 9.05, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "NORETHINDRONE (CONTRACEPTIVE) 0.35 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 4.76, "maximum": 6.56, "gross_charge": 8.2, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "BARICITINIB 2 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 152.57, "maximum": 210.44, "gross_charge": 263.05, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 152.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 210.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 187.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 187.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 152.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LIPASE-PROTEASE-AMYLASE 3,000-10,000-14,000 UNIT CAPSULE,DELAYED REL", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 473.28, "maximum": 652.8, "gross_charge": 816.0, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 473.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 581.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 652.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 581.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 473.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TOFACITINIB 10 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 169.97, "maximum": 234.44, "gross_charge": 293.05, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 234.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 208.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 208.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 169.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 169.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SERTRALINE 25 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.58, "maximum": 0.8, "gross_charge": 1.0, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "BALOXAVIR MARBOXIL 40 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 223.85, "maximum": 308.76, "gross_charge": 385.95, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 308.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 275.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 275.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 223.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 223.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SUMATRIPTAN 20 MG/ACTUATION NASAL SPRAY", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 23.06, "maximum": 31.8, "gross_charge": 39.75, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MESNA 400 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 143.75, "maximum": 198.28, "gross_charge": 247.85, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 143.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 198.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 176.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 176.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 143.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PRUCALOPRIDE 1 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 2.44, "maximum": 3.36, "gross_charge": 4.2, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CYCLOPENTOLATE 1 % EYE DROPS", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 2, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 4.35, "maximum": 6.0, "gross_charge": 7.5, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "UPADACITINIB ER 15 MG TABLET,EXTENDED RELEASE 24 HR", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 377.96, "maximum": 521.32, "gross_charge": 651.65, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 377.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 464.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 521.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 464.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 377.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "BARICITINIB 1 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 178.0, "maximum": 245.52, "gross_charge": 306.9, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 245.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 218.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 218.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 178.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 178.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MELOXICAM 7.5 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.23, "maximum": 0.32, "gross_charge": 0.4, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FLUVOXAMINE 25 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.41, "maximum": 0.56, "gross_charge": 0.7, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LEVONORGESTREL-ETHINYL ESTRADIOL 0.1 MG-20 MCG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.81, "maximum": 1.12, "gross_charge": 1.4, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MOMETASONE 50 MCG/ACTUATION HFA AEROSOL INHALER", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 13, "type": "GR"}, "standard_charges": [{"setting": "outpatient", "minimum": 72.56, "maximum": 100.08, "gross_charge": 125.1, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MEDIUM CHAIN TRIGLYCERIDES (MCT) 14 GRAM-120 KCAL/15 ML ORAL OIL", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 473, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 36.22, "maximum": 49.96, "gross_charge": 62.45, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CENOBAMATE 50 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 64.47, "maximum": 88.92, "gross_charge": 111.15, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 88.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CENOBAMATE 100 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 64.47, "maximum": 88.92, "gross_charge": 111.15, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 88.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DOLUTEGRAVIR 5 MG TABLET FOR ORAL SUSPENSION", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 17.37, "maximum": 23.96, "gross_charge": 29.95, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FENFLURAMINE 2.2 MG/ML ORAL SOLUTION", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 30, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 2393.08, "maximum": 3300.8, "gross_charge": 4126.0, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2393.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2393.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2941.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3300.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2941.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "AZITHROMYCIN 250 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.28, "maximum": 1.76, "gross_charge": 2.2, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LEVOCARNITINE 330 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.65, "maximum": 2.28, "gross_charge": 2.85, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FIDAXOMICIN 40 MG/ML ORAL SUSPENSION", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 136, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 3328.3, "maximum": 4590.76, "gross_charge": 5738.45, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4590.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4091.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4091.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3328.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3328.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CITALOPRAM 20 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.15, "maximum": 0.2, "gross_charge": 0.25, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FLUOXETINE 40 MG CAPSULE", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.32, "maximum": 0.44, "gross_charge": 0.55, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PONATINIB 30 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1090.92, "maximum": 1504.72, "gross_charge": 1880.9, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1090.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1341.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1504.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1341.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1090.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DESMOPRESSIN 10 MCG/SPRAY (0.1 ML) NASAL SPRAY (NON-REFRIGERATED)", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 49.01, "maximum": 67.6, "gross_charge": 84.5, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PENTOXIFYLLINE ER 400 MG TABLET,EXTENDED RELEASE", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.58, "maximum": 0.8, "gross_charge": 1.0, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DAPSONE 25 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.97, "maximum": 2.72, "gross_charge": 3.4, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "RIVAROXABAN 1 MG/ML ORAL SUSPENSION", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 155, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 951.52, "maximum": 1312.44, "gross_charge": 1640.55, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 951.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1169.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1312.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1169.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 951.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "BICTEGRAVIR 30 MG-EMTRICITABINE 120 MG-TENOFOVIR ALAFENAM 15 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 196.65, "maximum": 271.24, "gross_charge": 339.05, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 196.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 271.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 241.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 241.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 196.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "UPADACITINIB ER 30 MG TABLET,EXTENDED RELEASE 24 HR", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 377.96, "maximum": 521.32, "gross_charge": 651.65, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 377.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 464.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 521.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 464.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 377.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "UPADACITINIB ER 45 MG TABLET,EXTENDED RELEASE 24 HR", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 629.94, "maximum": 868.88, "gross_charge": 1086.1, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 868.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 774.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 774.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 629.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 629.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "QUETIAPINE 25 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.29, "maximum": 0.4, "gross_charge": 0.5, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "QUETIAPINE 100 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.41, "maximum": 0.56, "gross_charge": 0.7, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ZONISAMIDE 20 MG/ML ORAL SUSPENSION", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 150, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 890.18, "maximum": 1227.84, "gross_charge": 1534.8, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 890.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1094.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1227.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1094.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 890.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "POSACONAZOLE 300 MG ORAL SUSPENSION,DELAYED RELEASE IN A PACKET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 8, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 2384.84, "maximum": 3289.44, "gross_charge": 4111.8, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2384.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3289.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2931.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2931.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2384.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CLOPIDOGREL 75 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.41, "maximum": 0.56, "gross_charge": 0.7, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ELEXACAF 100 MG-TEZACAF 50 MG-IVACAF 75 MG(D)/IVACAF 75 MG(N) GRAN PK", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 519.27, "maximum": 716.24, "gross_charge": 895.3, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 716.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 638.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 638.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 519.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 519.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ELEXACAF 80 MG-TEZACAF 40 MG-IVACAF 60 MG(D)/IVACAF 59.5 MG(N) GRAN PK", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 519.27, "maximum": 716.24, "gross_charge": 895.3, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 519.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 519.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 638.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 716.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 638.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OFLOXACIN 0.3 % EAR DROPS", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 8.18, "maximum": 11.28, "gross_charge": 14.1, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CEFDINIR 300 MG CAPSULE", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.48, "maximum": 2.04, "gross_charge": 2.55, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CEFDINIR 125 MG/5 ML ORAL SUSPENSION", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 100, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 39.82, "maximum": 68.72, "gross_charge": 85.9, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CEFDINIR 125 MG/5 ML ORAL SUSPENSION", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 60, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 39.82, "maximum": 68.72, "gross_charge": 68.65, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ISAVUCONAZONIUM SULFATE 74.5 MG CAPSULE", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 66.44, "maximum": 91.64, "gross_charge": 114.55, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "METRONIDAZOLE 500 MG/5 ML ORAL SUSPENSION", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 200, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 342.61, "maximum": 472.56, "gross_charge": 590.7, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 342.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 472.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 421.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 421.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 342.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MONTELUKAST 5 MG CHEWABLE TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.31, "maximum": 1.8, "gross_charge": 2.25, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CENOBAMATE 25 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 64.47, "maximum": 88.92, "gross_charge": 111.15, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 88.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "URSODIOL 250 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.68, "maximum": 5.08, "gross_charge": 6.35, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "VIGABATRIN 100 MG/ML ORAL SOLUTION", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 150, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 5155.16, "maximum": 7110.56, "gross_charge": 8888.2, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7110.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6337.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6337.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 5155.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 5155.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CIPROFLOXACIN 500 MG/5 ML ORAL SUSPENSION", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 100, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 201.99, "maximum": 278.6, "gross_charge": 348.25, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 201.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 201.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 248.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 278.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 248.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HYDROXYUREA (SICKLE CELL) 100 MG/ML ORAL SOLUTION", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 148, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 1690.24, "maximum": 2331.36, "gross_charge": 2914.2, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2331.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2077.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2077.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1690.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1690.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HYDROXYUREA (SICKLE CELL) 200 MG CAPSULE", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 26.65, "maximum": 36.76, "gross_charge": 45.95, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CHOLESTYRAMINE 4 GRAM ORAL POWDER FOR SUSPENSION IN A PACKET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.91, "maximum": 2.64, "gross_charge": 3.3, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HYDROCHLOROTHIAZIDE 10 MG/ML ORAL SUSPENSION", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 7.77, "maximum": 10.72, "gross_charge": 13.4, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DIAZEPAM 2 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.17, "maximum": 0.24, "gross_charge": 0.3, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DIAZEPAM 5 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.17, "maximum": 0.24, "gross_charge": 0.3, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DICYCLOMINE 10 MG CAPSULE", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.73, "maximum": 1.0, "gross_charge": 1.25, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HYDROCORTISONE-ACETIC ACID 1 %-2 % EAR DROPS", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 90.92, "maximum": 125.4, "gross_charge": 156.75, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 111.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 125.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 111.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DIGOXIN 125 MCG (0.125 MG) TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 2.87, "maximum": 3.96, "gross_charge": 4.95, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DIGOXIN 250 MCG (0.25 MG) TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 2.87, "maximum": 3.96, "gross_charge": 4.95, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 2.9, "maximum": 4.0, "gross_charge": 5.0, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TIMOLOL MALEATE 0.5 % EYE GEL FORMING SOLUTION", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 157.82, "maximum": 217.68, "gross_charge": 272.1, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 157.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 157.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 194.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 217.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 194.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MODAFINIL 100 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 12.5, "maximum": 17.24, "gross_charge": 21.55, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OXYBUTYNIN CHLORIDE ER 15 MG TABLET,EXTENDED RELEASE 24 HR", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.62, "maximum": 2.24, "gross_charge": 2.8, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DILTIAZEM 30 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.58, "maximum": 0.8, "gross_charge": 1.0, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LEVALBUTEROL 0.63 MG/3 ML SOLUTION FOR NEBULIZATION", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 3, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.42, "maximum": 4.72, "gross_charge": 5.9, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LEVALBUTEROL 1.25 MG/3 ML SOLUTION FOR NEBULIZATION", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 3, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.42, "maximum": 4.72, "gross_charge": 5.9, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 3, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.52, "maximum": 0.72, "gross_charge": 0.9, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CIPROFLOXACIN 250 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.2, "maximum": 0.28, "gross_charge": 0.35, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DIPHENOXYLATE-ATROPINE 2.5 MG-0.025 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.38, "maximum": 0.52, "gross_charge": 0.65, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DIPYRIDAMOLE 25 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.99, "maximum": 1.36, "gross_charge": 1.7, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DIVALPROEX 250 MG TABLET,DELAYED RELEASE", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.35, "maximum": 0.48, "gross_charge": 0.6, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "RISPERIDONE 0.5 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.35, "maximum": 0.48, "gross_charge": 0.6, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DIVALPROEX 500 MG TABLET,DELAYED RELEASE", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.46, "maximum": 0.64, "gross_charge": 0.8, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.15, "maximum": 0.2, "gross_charge": 0.25, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DOXYCYCLINE HYCLATE 50 MG CAPSULE", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 2.49, "maximum": 3.44, "gross_charge": 4.3, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OSELTAMIVIR 75 MG CAPSULE", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 2.03, "maximum": 2.8, "gross_charge": 3.5, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CARBIDOPA 25 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.65, "maximum": 2.28, "gross_charge": 2.85, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LEVETIRACETAM 250 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.32, "maximum": 0.44, "gross_charge": 0.55, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LEVETIRACETAM 500 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.35, "maximum": 0.48, "gross_charge": 0.6, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MONTELUKAST 4 MG CHEWABLE TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.45, "maximum": 2.0, "gross_charge": 2.5, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 15.37, "maximum": 21.2, "gross_charge": 26.5, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 20.59, "maximum": 28.4, "gross_charge": 35.5, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 26.85, "maximum": 37.04, "gross_charge": 46.3, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "RIZATRIPTAN 5 MG DISINTEGRATING TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 2.81, "maximum": 3.88, "gross_charge": 4.85, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.51, "maximum": 2.08, "gross_charge": 2.6, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.94, "maximum": 5.44, "gross_charge": 6.8, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CARBAMAZEPINE ER 200 MG TABLET,EXTENDED RELEASE,12 HR", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.91, "maximum": 2.64, "gross_charge": 3.3, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TOPIRAMATE 15 MG SPRINKLE CAPSULE", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 2.61, "maximum": 3.6, "gross_charge": 4.5, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TOPIRAMATE 25 MG SPRINKLE CAPSULE", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.28, "maximum": 1.76, "gross_charge": 2.2, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FLUORESCEIN 1 MG EYE STRIPS", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.52, "maximum": 0.72, "gross_charge": 0.9, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LANSOPRAZOLE 15 MG CAPSULE,DELAYED RELEASE", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 4.76, "maximum": 6.56, "gross_charge": 8.2, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LANSOPRAZOLE 30 MG CAPSULE,DELAYED RELEASE", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.6, "maximum": 2.2, "gross_charge": 2.75, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ZONISAMIDE 100 MG CAPSULE", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.07, "maximum": 1.48, "gross_charge": 1.85, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.9, "maximum": 1.24, "gross_charge": 1.55, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.96, "maximum": 1.32, "gross_charge": 1.65, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FENTANYL 25 MCG/HR TRANSDERMAL PATCH", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 17.02, "maximum": 23.48, "gross_charge": 29.35, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FENTANYL 50 MCG/HR TRANSDERMAL PATCH", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 26.88, "maximum": 37.08, "gross_charge": 46.35, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OLANZAPINE 5 MG DISINTEGRATING TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.83, "maximum": 2.52, "gross_charge": 3.15, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LINEZOLID 600 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 4.23, "maximum": 5.84, "gross_charge": 7.3, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LINEZOLID 100 MG/5 ML ORAL SUSPENSION", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 150, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 817.45, "maximum": 1127.52, "gross_charge": 1409.4, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1127.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1004.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1004.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 817.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 817.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.22, "maximum": 1.68, "gross_charge": 2.1, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) CAPSULE", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.83, "maximum": 2.52, "gross_charge": 3.15, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "METHYLPHENIDATE ER 18 MG TABLET,EXTENDED RELEASE 24 HR", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 7.8, "maximum": 10.76, "gross_charge": 13.45, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 2, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 7.63, "maximum": 10.52, "gross_charge": 13.15, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "NEOMYCIN-POLYMYXIN-HYDROCORT 3.5 MG-10,000 UNIT/ML-1 % EAR DROPS,SUSP", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 66.76, "maximum": 92.08, "gross_charge": 115.1, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HYDROCORTISONE 1 %-PRAMOXINE 1 % RECTAL FOAM", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 10, "type": "GR"}, "standard_charges": [{"setting": "outpatient", "minimum": 145.38, "maximum": 200.52, "gross_charge": 250.65, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 200.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 178.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 178.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 145.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 145.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 3, "type": "GR"}, "standard_charges": [{"setting": "outpatient", "minimum": 8.9, "maximum": 12.28, "gross_charge": 15.35, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ERYTHROMYCIN 250 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 5.22, "maximum": 7.2, "gross_charge": 9.0, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL POWDER FOR SUSPENSION", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 100, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 226.98, "maximum": 313.08, "gross_charge": 391.35, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 226.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 226.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 279.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 313.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 279.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.75, "maximum": 1.04, "gross_charge": 1.3, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ERYTHROMYCIN ETHYLSUCCINATE 400 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 22.71, "maximum": 31.32, "gross_charge": 39.15, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "METHYLPHENIDATE ER 54 MG TABLET,EXTENDED RELEASE 24 HR", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 8.24, "maximum": 11.36, "gross_charge": 14.2, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ZIPRASIDONE 20 MG CAPSULE", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 11.54, "maximum": 15.92, "gross_charge": 19.9, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HYPROMELLOSE 2 % INTRAOCULAR SYRINGE", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 186.73, "maximum": 257.56, "gross_charge": 321.95, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 257.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 229.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 229.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 186.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 186.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "VALGANCICLOVIR 450 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 25.32, "maximum": 34.92, "gross_charge": 43.65, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ALLOPURINOL 100 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.41, "maximum": 0.56, "gross_charge": 0.7, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ALLOPURINOL 300 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.81, "maximum": 1.12, "gross_charge": 1.4, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DEXTROAMPHETAMINE-AMPHETAMINE ER 20 MG 24HR CAPSULE,EXTEND RELEASE", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.89, "maximum": 2.6, "gross_charge": 3.25, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DEXMETHYLPHENIDATE 5 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.73, "maximum": 1.0, "gross_charge": 1.25, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "BOSENTAN 62.5 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 41.15, "maximum": 56.76, "gross_charge": 70.95, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FLUOCINONIDE 0.05 % TOPICAL OINTMENT", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 15, "type": "GR"}, "standard_charges": [{"setting": "outpatient", "minimum": 10.12, "maximum": 13.96, "gross_charge": 17.45, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PIMECROLIMUS 1 % TOPICAL CREAM", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 30, "type": "GR"}, "standard_charges": [{"setting": "outpatient", "minimum": 553.41, "maximum": 763.32, "gross_charge": 954.15, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 763.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 680.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 680.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 553.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 553.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FLUOROMETHOLONE 0.1 % EYE DROPS,SUSPENSION", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 61.63, "maximum": 85.0, "gross_charge": 106.25, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ALPRAZOLAM 0.25 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.12, "maximum": 0.16, "gross_charge": 0.2, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "METHYLPHENIDATE ER 27 MG TABLET,EXTENDED RELEASE 24 HR", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 11.31, "maximum": 15.6, "gross_charge": 19.5, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FUROSEMIDE 40 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.15, "maximum": 0.2, "gross_charge": 0.25, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "IMATINIB 100 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 6.84, "maximum": 9.44, "gross_charge": 11.8, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DEXTROAMPHETAMINE-AMPHETAMINE ER 5 MG 24HR CAPSULE,EXTEND RELEASE", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 2.41, "maximum": 3.32, "gross_charge": 4.15, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "VORICONAZOLE 200 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 46.72, "maximum": 64.44, "gross_charge": 80.55, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG CHEWABLE TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 9.37, "maximum": 12.92, "gross_charge": 16.15, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.7, "maximum": 0.96, "gross_charge": 1.2, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 4.0, "maximum": 5.52, "gross_charge": 6.9, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ESCITALOPRAM 10 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.44, "maximum": 0.6, "gross_charge": 0.75, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "AMOXICILLIN-POTASSIUM CLAVULANATE 1,000 MG-62.5 MG TABLET,EXT.REL 12HR", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 13.43, "maximum": 18.52, "gross_charge": 23.15, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "GENTAMICIN 0.1 % TOPICAL CREAM", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 15, "type": "GR"}, "standard_charges": [{"setting": "outpatient", "minimum": 31.44, "maximum": 43.36, "gross_charge": 54.2, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "GENTIAN VIOLET 1 % TOPICAL SOLUTION", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 59, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 4.73, "maximum": 6.52, "gross_charge": 8.15, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ARIPIPRAZOLE 10 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.93, "maximum": 1.28, "gross_charge": 1.6, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ATOMOXETINE 18 MG CAPSULE", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 2.58, "maximum": 3.56, "gross_charge": 4.45, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ATOMOXETINE 25 MG CAPSULE", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 4.61, "maximum": 6.36, "gross_charge": 7.95, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ATOMOXETINE 40 MG CAPSULE", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 7.08, "maximum": 9.76, "gross_charge": 12.2, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.48, "maximum": 2.04, "gross_charge": 2.55, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LANSOPRAZOLE 15 MG DELAYED RELEASE,DISINTEGRATING TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 19.14, "maximum": 26.4, "gross_charge": 33.0, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 4.29, "maximum": 5.92, "gross_charge": 7.4, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "BUPRENORPHINE HCL 8 MG SUBLINGUAL TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 7.37, "maximum": 10.16, "gross_charge": 12.7, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CYCLOBENZAPRINE 5 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.9, "maximum": 1.24, "gross_charge": 1.55, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CYCLOSPORINE 0.05 % EYE DROPS IN A DROPPERETTE", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 25.69, "maximum": 35.44, "gross_charge": 44.3, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CLONAZEPAM 0.125 MG DISINTEGRATING TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 2.23, "maximum": 3.08, "gross_charge": 3.85, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CLONAZEPAM 0.25 MG DISINTEGRATING TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 2.23, "maximum": 3.08, "gross_charge": 3.85, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CLONAZEPAM 2 MG DISINTEGRATING TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.39, "maximum": 1.92, "gross_charge": 2.4, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "RISPERIDONE 0.5 MG DISINTEGRATING TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.05, "maximum": 4.2, "gross_charge": 5.25, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "RISPERIDONE 1 MG DISINTEGRATING TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 4.0, "maximum": 5.52, "gross_charge": 6.9, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MOXIFLOXACIN 0.5 % EYE DROPS", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 3, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 8.61, "maximum": 11.88, "gross_charge": 14.85, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HALOPERIDOL 1 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.87, "maximum": 1.2, "gross_charge": 1.5, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HALOPERIDOL 5 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.74, "maximum": 2.4, "gross_charge": 3.0, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "IMATINIB 400 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 6.12, "maximum": 8.44, "gross_charge": 10.55, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "AMANTADINE HCL 100 MG CAPSULE", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.97, "maximum": 2.72, "gross_charge": 3.4, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ARIPIPRAZOLE 5 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.7, "maximum": 0.96, "gross_charge": 1.2, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CIPROFLOXACIN 0.3 %-DEXAMETHASONE 0.1 % EAR DROPS,SUSPENSION", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 7, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 87.52, "maximum": 120.72, "gross_charge": 150.9, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 107.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 107.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.35, "maximum": 0.48, "gross_charge": 0.6, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HYDRALAZINE 10 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.44, "maximum": 0.6, "gross_charge": 0.75, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ZONISAMIDE 25 MG CAPSULE", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.38, "maximum": 0.52, "gross_charge": 0.65, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HYDRALAZINE 25 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.35, "maximum": 0.48, "gross_charge": 0.6, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HYDRALAZINE 50 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.52, "maximum": 0.72, "gross_charge": 0.9, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HYDROCHLOROTHIAZIDE 50 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.06, "maximum": 0.08, "gross_charge": 0.1, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HYDROCORTISONE 2.5 % TOPICAL OINTMENT", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 28, "type": "GR"}, "standard_charges": [{"setting": "outpatient", "minimum": 2.49, "maximum": 3.44, "gross_charge": 4.3, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HYDROCORTISONE 10 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 2.93, "maximum": 4.04, "gross_charge": 5.05, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.02, "maximum": 4.16, "gross_charge": 5.2, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CARBAMAZEPINE ER 100 MG CAPSULE,EXTENDED RELEASE MPHASE12HR", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 4.23, "maximum": 5.84, "gross_charge": 7.3, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HYDROMORPHONE 2 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.75, "maximum": 1.04, "gross_charge": 1.3, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "METOPROLOL TARTRATE 25 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.12, "maximum": 0.16, "gross_charge": 0.2, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HYDROXYZINE HCL 10 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.38, "maximum": 0.52, "gross_charge": 0.65, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HYDROXYZINE HCL 25 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.41, "maximum": 0.56, "gross_charge": 0.7, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HYOSCYAMINE 0.125 MG/ML ORAL DROPS", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 15, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 43.82, "maximum": 60.44, "gross_charge": 75.55, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "IMIPRAMINE 25 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.17, "maximum": 0.24, "gross_charge": 0.3, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "INDOMETHACIN 25 MG CAPSULE", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.55, "maximum": 0.76, "gross_charge": 0.95, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "INDOMETHACIN 50 MG RECTAL SUPPOSITORY", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 234.26, "maximum": 323.12, "gross_charge": 403.9, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 323.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 287.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 234.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 287.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 234.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 15, "type": "GR"}, "standard_charges": [{"setting": "outpatient", "minimum": 4.5, "maximum": 6.2, "gross_charge": 7.75, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DULOXETINE 30 MG CAPSULE,DELAYED RELEASE", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.58, "maximum": 0.8, "gross_charge": 1.0, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FLECAINIDE SUSPENSION 20 MG/ML", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 60, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 16.88, "maximum": 23.28, "gross_charge": 29.1, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ISONIAZID 300 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 4.93, "maximum": 6.8, "gross_charge": 8.5, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "AMLODIPINE 1 MG/ML SUSP", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 350, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 12.96, "maximum": 17.88, "gross_charge": 22.35, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "URSODIOL 60 MG/ML SUSPENSION", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 120, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 156.48, "maximum": 215.84, "gross_charge": 269.8, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 215.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 192.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 156.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 192.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 156.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FENTANYL 12 MCG/HR TRANSDERMAL PATCH", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 34.48, "maximum": 47.56, "gross_charge": 59.45, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DEXMETHYLPHENIDATE ER 5 MG CAPSULE,EXTENDED RELEASE BIPHASIC50-50", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 2.9, "maximum": 4.0, "gross_charge": 5.0, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DEXMETHYLPHENIDATE ER 10 MG CAPSULE,EXTENDED RELEASE BIPHASIC50-50", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 5.54, "maximum": 7.64, "gross_charge": 9.55, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.22, "maximum": 1.68, "gross_charge": 2.1, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PREGABALIN 25 MG CAPSULE", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.99, "maximum": 1.36, "gross_charge": 1.7, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PREGABALIN 100 MG CAPSULE", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.99, "maximum": 1.36, "gross_charge": 1.7, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PREGABALIN 150 MG CAPSULE", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.99, "maximum": 1.36, "gross_charge": 1.7, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "AMITRIPTYLINE 10 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.64, "maximum": 0.88, "gross_charge": 1.1, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "AMITRIPTYLINE 25 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.58, "maximum": 0.8, "gross_charge": 1.0, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DIGOXIN 50 MCG/ML (0.05 MG/ML) ORAL SOLUTION", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 60, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 116.64, "maximum": 160.88, "gross_charge": 201.1, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 160.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 143.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 116.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 143.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 116.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LEUCOVORIN CALCIUM 25 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 15.37, "maximum": 21.2, "gross_charge": 26.5, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LEUCOVORIN CALCIUM 5 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.77, "maximum": 5.2, "gross_charge": 6.5, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LEVOTHYROXINE 25 MCG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.67, "maximum": 0.92, "gross_charge": 1.15, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LEVOTHYROXINE 50 MCG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.7, "maximum": 0.96, "gross_charge": 1.2, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LEVOTHYROXINE 100 MCG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.87, "maximum": 1.2, "gross_charge": 1.5, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "AMOXICILLIN 250 MG CAPSULE", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.36, "maximum": 4.64, "gross_charge": 5.8, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "AMOXICILLIN 250 MG CHEWABLE TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.7, "maximum": 0.96, "gross_charge": 1.2, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LISINOPRIL 20 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.15, "maximum": 0.2, "gross_charge": 0.25, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LOPERAMIDE 2 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.23, "maximum": 0.32, "gross_charge": 0.4, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MEDROXYPROGESTERONE 10 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 2.52, "maximum": 3.48, "gross_charge": 4.35, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MEGESTROL 20 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.35, "maximum": 0.48, "gross_charge": 0.6, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "METHADONE 5 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.75, "maximum": 1.04, "gross_charge": 1.3, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "METHAZOLAMIDE 25 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 4.9, "maximum": 6.76, "gross_charge": 8.45, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "METHOCARBAMOL 500 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.38, "maximum": 0.52, "gross_charge": 0.65, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "METHYLPHENIDATE 5 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 4.44, "maximum": 6.12, "gross_charge": 7.65, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "AMIODARONE ORAL SUSPENSION 5 MG/ML", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 120, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.8, "maximum": 2.48, "gross_charge": 3.1, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CLOPIDOGREL ORAL SUSPENSION 5 MG/ML", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 60, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 2.52, "maximum": 3.48, "gross_charge": 4.35, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DANTROLENE SYRUP 5 MG/ML", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 100, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 47.85, "maximum": 66.0, "gross_charge": 82.5, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DIPYRIDAMOLE SUSPENSION 10 MG/ML", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 60, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 10.96, "maximum": 15.12, "gross_charge": 18.9, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FLUCYTOSINE SUSPENSION 50 MG/ML", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 120, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 1627.71, "maximum": 2245.12, "gross_charge": 2806.4, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2245.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2000.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1627.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2000.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1627.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HYDROCHLOROTHIAZIDE SUSPENSION 5 MG/ML", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 120, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.9, "maximum": 1.24, "gross_charge": 1.55, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ISRADIPINE SUSPENSION 1 MG/ML", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 100, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 99.53, "maximum": 137.28, "gross_charge": 171.6, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 137.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 122.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 122.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PROPYLTHIOURACIL SUSPENSION 5 MG/ML", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 100, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 37.38, "maximum": 51.56, "gross_charge": 64.45, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SEVELAMER SYRUP 50 MG/ML", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 160, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 128.18, "maximum": 176.8, "gross_charge": 221.0, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 176.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 157.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 128.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 157.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 128.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SODIUM BENZOATE ORAL SOLN", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 300, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.71, "maximum": 5.12, "gross_charge": 6.4, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SODIUM PHENYLBUTYRATE SUSPENSION 200 MG/ML", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 60, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 277.15, "maximum": 382.28, "gross_charge": 477.85, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 382.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 340.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 277.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 340.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 277.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SPIRONOLACTONE-HCTZ SUSPENSION 5-5 MG/ML", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 120, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 79.43, "maximum": 109.56, "gross_charge": 136.95, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 97.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 109.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 97.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "THIOGUANINE SYRUP 40 MG/ML", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 30, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 998.12, "maximum": 1376.72, "gross_charge": 1720.9, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1376.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1227.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 998.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1227.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 998.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "VALACYCLOVIR SYRUP 50 MG/ML", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 120, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 10.67, "maximum": 14.72, "gross_charge": 18.4, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "VERAPAMIL ORAL SUSPENSION 2 MG/ML", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 120, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.61, "maximum": 0.84, "gross_charge": 1.05, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ZINC SULFATE SUSPENSION (2 MG/ML OF ELEMENTAL ZINC)", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 75, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.93, "maximum": 1.28, "gross_charge": 1.6, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ZONISAMIDE SYRUP 10 MG/ML", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 150, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 26.68, "maximum": 36.8, "gross_charge": 46.0, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "METOCLOPRAMIDE 10 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.04, "maximum": 1.44, "gross_charge": 1.8, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LITHIUM CARBONATE 300 MG TABLET/CAPSULE (SO)", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.44, "maximum": 0.6, "gross_charge": 0.75, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FLUOXETINE 10 MG ORAL TAB/CAP (SO)", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.32, "maximum": 0.44, "gross_charge": 0.55, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ACETAZOLAMIDE ORAL SUSP 25 MG/ML", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 30, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 17.4, "maximum": 24.0, "gross_charge": 30.0, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ALLOPURINOL ORAL SUSPENSION 20 MG/ML", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 120, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 6.24, "maximum": 8.6, "gross_charge": 10.75, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CLONAZEPAM ORAL SUSPENSION 0.1 MG/ML", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 2, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.03, "maximum": 0.04, "gross_charge": 0.05, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DILTIAZEM ORAL SUSPENSION 12 MG/ML", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 120, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 26.1, "maximum": 36.0, "gross_charge": 45.0, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HYDROXYCHLOROQUINE ORAL SUSPENSION 25 MG/ML", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 56, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 14.82, "maximum": 20.44, "gross_charge": 25.55, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LOSARTAN ORAL SUSPENSION 2.5 MG/ML", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 100, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 13.08, "maximum": 18.04, "gross_charge": 22.55, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "METOLAZONE ORAL SUSPENSION 1 MG/ML", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 60, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 55.77, "maximum": 76.92, "gross_charge": 96.15, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PYRAZINAMIDE ORAL SUSPENSION 100 MG/ML", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 60, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 86.42, "maximum": 119.2, "gross_charge": 149.0, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 119.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CAPTOPRIL ORAL SUSPENSION 1 MG/ML", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 100, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.22, "maximum": 4.44, "gross_charge": 5.55, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CARVEDILOL ORAL SUSPENSION 1.67 MG/ML", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 30, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.32, "maximum": 0.44, "gross_charge": 0.55, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CLONIDINE ORAL SUSPENSION 20 MCG/ML", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 300, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.71, "maximum": 5.12, "gross_charge": 6.4, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "METOPROLOL TARTRATE 50 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.17, "maximum": 0.24, "gross_charge": 0.3, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HYDROCORTISONE ORAL SUSPENSION 2 MG/ML", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 27.12, "maximum": 37.4, "gross_charge": 46.75, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HYDROXYUREA ORAL SUSPENSION 100 MG/ML", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 16.18, "maximum": 22.32, "gross_charge": 27.9, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LABETALOL ORAL SUSPENSION 40 MG/ML", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 60, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 12.15, "maximum": 16.76, "gross_charge": 20.95, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "BOSENTAN ORAL SUSPENSION 6.25 MG/ML", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 60, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 185.11, "maximum": 255.32, "gross_charge": 319.15, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 185.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 227.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 185.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 255.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 227.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "AMOXICILLIN 500 MG TAB/CAP (SO)", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.29, "maximum": 0.4, "gross_charge": 0.5, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "METRONIDAZOLE 250 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.55, "maximum": 0.76, "gross_charge": 0.95, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "METRONIDAZOLE 500 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.04, "maximum": 1.44, "gross_charge": 1.8, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "RIFAMPIN ORAL SUSPENSION 25 MG/ML", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 120, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 32.86, "maximum": 45.32, "gross_charge": 56.65, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LANSOPRAZOLE SUSPENSION 3 MG/ML SIMPLE", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.87, "maximum": 2.88, "gross_charge": 3.6, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE (SO)", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.6, "maximum": 2.2, "gross_charge": 2.75, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MORPHINE 0.4 MG/ML ORAL SOLUTION (NEONATE)", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.06, "maximum": 0.08, "gross_charge": 0.1, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "WARFARIN SODIUM 0.5 MG SPLIT TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.17, "maximum": 0.24, "gross_charge": 0.3, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OXYMETAZOLINE 0.025% AND LIDOCAINE 2% 15 ML (PREMIX)", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 15, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.31, "maximum": 1.8, "gross_charge": 2.25, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "GLYBURIDE 1 MG/ML ORAL SUSPENSION", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 30, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 2.76, "maximum": 3.8, "gross_charge": 4.75, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "RIFAXIMIN ORAL SUSPENSION 20 MG/ML", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 60, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 160.2, "maximum": 220.96, "gross_charge": 276.2, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 220.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 196.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 160.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 196.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 160.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "AMITRIPTYLINE 1 MG/ML ORAL SYRUP", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 100, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 2.47, "maximum": 3.4, "gross_charge": 4.25, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MEXILETINE ORAL SUSPENSION 10 MG/ML", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 120, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 23.37, "maximum": 32.24, "gross_charge": 40.3, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PEG 3350-ELECTROLYTES 4 LITER SOLUTION (SO)", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 4000, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 17.4, "maximum": 24.0, "gross_charge": 30.0, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TIMOLOL MALEATE 0.5 % TOPICAL GEL FORMING SOLUTION", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 157.82, "maximum": 217.68, "gross_charge": 272.1, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 217.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 194.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 157.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 194.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 157.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PHENOXYBENZAMINE 2 MG/ML ORAL SUSPENSION", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 857.1, "maximum": 1182.2, "gross_charge": 1477.75, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 857.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1053.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 857.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1182.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1053.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PENTOXIFYLLINE 20 MG/ML ORAL SUSPENSION (SIMPLE)", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 60, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 2.38, "maximum": 3.28, "gross_charge": 4.1, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SPIRONOLACTONE 12.5 MG SPLIT TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.15, "maximum": 0.2, "gross_charge": 0.25, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TOPIRAMATE 12.5 MG SPLIT TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.29, "maximum": 0.4, "gross_charge": 0.5, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CLOBAZAM 5 MG SPLIT TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.73, "maximum": 1.0, "gross_charge": 1.25, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "COLCHICINE 0.3 MG SPLIT TAB", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.73, "maximum": 1.0, "gross_charge": 1.25, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OXCARBAZEPINE 75 MG SPLIT TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.32, "maximum": 0.44, "gross_charge": 0.55, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MERCAPTOPURINE 25 MG SPLIT TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 2.84, "maximum": 3.92, "gross_charge": 4.9, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "METHIMAZOLE 2.5 MG SPLIT TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.17, "maximum": 0.24, "gross_charge": 0.3, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OXYMETAZOLINE 0.05 % NASAL SPRAY (SO)", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 30, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.84, "maximum": 1.16, "gross_charge": 1.45, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SODIUM CHLORIDE 1 GRAM TABLET FOR CRUSH-DISSOLVE PARTIAL TABLET DOSES", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.15, "maximum": 0.2, "gross_charge": 0.25, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ELEXACAFTOR 100 MG-TEZACAFTOR 50 MG-IVACAFTOR 75 MG (FROM TRIKAFTA) TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 366.59, "maximum": 505.64, "gross_charge": 632.05, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 505.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 450.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 366.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 450.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 366.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "IVACAFTOR 150 MG TABLET (FROM TRIKAFTA)", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 366.59, "maximum": 505.64, "gross_charge": 632.05, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 366.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 450.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 366.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 505.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 450.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "NIMODIPINE 6 MG/ML ORAL SOLUTION (SO)", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 125.37, "maximum": 172.92, "gross_charge": 216.15, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 172.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 154.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 125.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 154.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 125.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SULFASALAZINE ORAL SUSPENSION 100 MG/ML", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 100, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 8.38, "maximum": 11.56, "gross_charge": 14.45, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TIMOLOL MALEATE 0.5 % TOPICAL DROPS", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 6.29, "maximum": 8.68, "gross_charge": 10.85, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "METHIMAZOLE 3 MG/ML ORAL SUSPENSION", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 40, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 15.49, "maximum": 21.36, "gross_charge": 26.7, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET FOR CRUSH-DISSOLVE PARTIAL TABLET DOSES", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.22, "maximum": 1.68, "gross_charge": 2.1, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CLOBAZAM 10 MG TABLET FOR CRUSH-DISSOLVE PARTIAL TABLET DOSES", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 5.45, "maximum": 7.52, "gross_charge": 9.4, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CLONIDINE HCL 0.1 MG TABLET FOR CRUSH-DISSOLVE PARTIAL TABLET DOSES", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.52, "maximum": 0.72, "gross_charge": 0.9, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "GLYCOPYRROLATE 1 MG TABLET FOR CRUSH-DISSOLVE PARTIAL TABLET DOSES", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.29, "maximum": 0.4, "gross_charge": 0.5, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "QUETIAPINE 25 MG TABLET FOR CRUSH-DISSOLVE PARTIAL TABLET DOSES", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.29, "maximum": 0.4, "gross_charge": 0.5, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "BUMETANIDE 0.5 MG TABLET FOR CRUSH-DISSOLVE PARTIAL TABLET DOSES", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.73, "maximum": 1.0, "gross_charge": 1.25, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SERTRALINE 50 MG TABLET FOR CRUSH-DISSOLVE PARTIAL TABLET DOSES", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.61, "maximum": 0.84, "gross_charge": 1.05, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ESCITALOPRAM 10 MG TABLET FOR CRUSH-DISSOLVE PARTIAL TABLET DOSES", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.44, "maximum": 0.6, "gross_charge": 0.75, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "METHOCARBAMOL 500 MG TABLET FOR CRUSH-DISSOLVE PARTIAL TABLET DOSES", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.38, "maximum": 0.52, "gross_charge": 0.65, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "BOSENTAN 31.25 MG SPLIT TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 23.14, "maximum": 31.92, "gross_charge": 39.9, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "AMBRISENTAN 2.5 MG SPLIT TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 50.75, "maximum": 70.0, "gross_charge": 87.5, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "RUXOLITINIB 2.5 MG SPLIT TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 248.7, "maximum": 343.04, "gross_charge": 428.8, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 248.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 305.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 248.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 343.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 305.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "INSULIN GLARGINE (U-100) 100 UNIT/ML (3 ML) SUBCUTANEOUS PEN (SO)", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 3, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 56.14, "maximum": 77.44, "gross_charge": 96.8, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "IVABRADINE 2.5 MG SPLIT TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 12.47, "maximum": 17.2, "gross_charge": 21.5, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CAFFEINE CITRATE 20 MG/ML ORAL SOLUTION ORDERABLE", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 120, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 3279.61, "maximum": 4523.6, "gross_charge": 5654.5, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4523.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4031.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3279.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4031.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3279.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ELEXACAFTOR 50 MG-TEZACAFTOR 25 MG-IVACAFTOR 37.5 MG (FROM TRIKAFTA) TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 346.17, "maximum": 477.48, "gross_charge": 596.85, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 346.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 425.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 346.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 477.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 425.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "IVACAFTOR 75 MG TABLET (FROM TRIKAFTA)", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 346.17, "maximum": 477.48, "gross_charge": 596.85, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 477.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 425.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 346.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 425.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 346.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "RIBAVIRIN 40 MG/ML ORAL SUSPENSION", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 100, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 24.51, "maximum": 33.8, "gross_charge": 42.25, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SACUBITRIL-VALSARTAN 4 MG/ML ORAL SUSPENSION", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 100, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 75.17, "maximum": 103.68, "gross_charge": 129.6, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SODIUM CHLORIDE 1 GRAM TABLET (SO)", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.15, "maximum": 0.2, "gross_charge": 0.25, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LEVOTHYROXINE 100 MCG TABLET FOR CRUSH-DISSOLVE PARTIAL TABLET DOSES", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.87, "maximum": 1.2, "gross_charge": 1.5, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "THIOGUANINE 20 MG SPLIT TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 178.99, "maximum": 246.88, "gross_charge": 308.6, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 178.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 220.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 178.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 246.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 220.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LACOSAMIDE 100 MG TABLET FOR CRUSH-DISSOLVE PARTIAL TABLET DOSES", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 5.13, "maximum": 7.08, "gross_charge": 8.85, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "RIFAXIMIN 550 MG TABLET FOR CRUSH-DISSOLVE PARTIAL TABLET DOSES", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 96.92, "maximum": 133.68, "gross_charge": 167.1, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 96.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 119.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 96.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 133.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 119.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CIPROFLOXACIN 250 MG TABLET FOR CRUSH-DISSOLVE PARTIAL TABLET DOSES", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.26, "maximum": 0.36, "gross_charge": 0.45, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LEVETIRACETAM 500 MG TABLET FOR CRUSH-DISSOLVE PARTIAL TABLET DOSES", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.35, "maximum": 0.48, "gross_charge": 0.6, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ATROPINE 1 % SUBLINGUAL DROPS", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 28.54, "maximum": 39.36, "gross_charge": 49.2, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OXYCODONE 5 MG TABLET FOR CRUSH-DISSOLVE PARTIAL TABLET DOSES", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.73, "maximum": 1.0, "gross_charge": 1.25, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OLANZAPINE 5 MG DISINTEGRATING TABLET FOR CRUSH-DISSOLVE PARTIAL TABLET DOSES", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.83, "maximum": 2.52, "gross_charge": 3.15, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LOPERAMIDE 2 MG TABLET FOR CRUSH-DISSOLVE PARTIAL TABLET DOSES", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.23, "maximum": 0.32, "gross_charge": 0.4, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ELEXACAFTOR 100 MG-TEZACAFTOR 50 MG-IVACAFTOR 75 MG (FROM TRIKAFTA) ORAL GRANULES", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 519.27, "maximum": 716.24, "gross_charge": 895.3, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 716.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 638.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 519.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 638.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 519.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "IVACAFTOR 75 MG ORAL GRANULES (FROM TRIKAFTA)", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 519.27, "maximum": 716.24, "gross_charge": 895.3, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 519.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 638.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 519.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 716.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 638.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ELEXACAFTOR 80 MG-TEZACAFTOR 40 MG-IVACAFTOR 60 MG (FROM TRIKAFTA) ORAL GRANULES", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 519.27, "maximum": 716.24, "gross_charge": 895.3, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 716.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 638.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 519.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 638.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 519.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "IVACAFTOR 59.5 MG ORAL GRANULES (FROM TRIKAFTA)", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 519.27, "maximum": 716.24, "gross_charge": 895.3, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 519.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 638.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 519.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 716.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 638.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CENOBAMATE 50 MG TABLET FOR CRUSH-DISSOLVE PARTIAL TABLET DOSES", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 64.47, "maximum": 88.92, "gross_charge": 111.15, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 88.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CENOBAMATE 12.5 MG SPLIT TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 22.24, "maximum": 30.68, "gross_charge": 38.35, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "EMTRICITABINE 100 MG-TENOFOVIR DISOPROXIL FUMARATE 150 MG TABLET FOR CRUSH-DISSOLVE PARTIAL TABLET DOSES", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 24.77, "maximum": 34.16, "gross_charge": 42.7, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "EMTRICITABINE 133 MG-TENOFOVIR DISOPROXIL FUMARATE 200 MG TABLET FOR CRUSH-DISSOLVE PARTIAL TABLET DOSES", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 103.12, "maximum": 142.24, "gross_charge": 177.8, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 126.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 142.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 126.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "EMTRICITABINE 167 MG-TENOFOVIR DISOPROXIL FUMARATE 250 MG TABLET FOR CRUSH-DISSOLVE PARTIAL TABLET DOSES", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 26.01, "maximum": 35.88, "gross_charge": 44.85, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DOLUTEGRAVIR 50 MG TABLET FOR CRUSH-DISSOLVE PARTIAL TABLET DOSES", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 130.15, "maximum": 179.52, "gross_charge": 224.4, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 130.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 160.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 130.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 179.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 160.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FELBAMATE 600 MG TABLET FOR CRUSH-DISSOLVE PARTIAL TABLET DOSES", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 2.93, "maximum": 4.04, "gross_charge": 5.05, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PHENOBARBITAL 64.8 MG TABLET FOR CRUSH-DISSOLVE PARTIAL TABLET DOSES", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.6, "maximum": 2.2, "gross_charge": 2.75, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "METHADONE 5 MG TABLET FOR CRUSH-DISSOLVE PARTIAL TABLET DOSES", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.75, "maximum": 1.04, "gross_charge": 1.3, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MOXIFLOXACIN ORAL SUSPENSION 20 MG/ML", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 60, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 28.07, "maximum": 38.72, "gross_charge": 48.4, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CHOLESTYRAMINE 20% OINTMENT (SIMPLE)", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 100, "type": "GR"}, "standard_charges": [{"setting": "outpatient", "minimum": 2.81, "maximum": 3.88, "gross_charge": 4.85, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "RUFINAMIDE 400 MG TABLET FOR CRUSH-DISSOLVE PARTIAL TABLET DOSES", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 49.01, "maximum": 67.6, "gross_charge": 84.5, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LAMOTRIGINE 100 MG TABLET FOR CRUSH-DISSOLVE PARTIAL TABLET DOSES", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.38, "maximum": 0.52, "gross_charge": 0.65, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "EMPAGLIFLOZIN 10 MG TABLET FOR CRUSH-DISSOLVE PARTIAL TABLET DOSES", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 21.23, "maximum": 29.28, "gross_charge": 36.6, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TADALAFIL 20 MG TABLET (PULMONARY HYPERTENSION) FOR CRUSH-DISSOLVE PARTIAL TABLET DOSES", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.77, "maximum": 2.44, "gross_charge": 3.05, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PROPRANOLOL 40 MG TABLET FOR CRUSH-DISSOLVE PARTIAL TABLET DOSES", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.04, "maximum": 1.44, "gross_charge": 1.8, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DIAZEPAM 5 MG TABLET FOR CRUSH-DISSOLVE PARTIAL TABLET DOSES", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.17, "maximum": 0.24, "gross_charge": 0.3, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PRUCALOPRIDE 1 MG TABLET FOR CRUSH-DISSOLVE PARTIAL TABLET DOSES", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 2.44, "maximum": 3.36, "gross_charge": 4.2, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "METRONIDAZOLE 500 MG TABLET FOR CRUSH-DISSOLVE PARTIAL TABLET DOSES", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.04, "maximum": 1.44, "gross_charge": 1.8, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "RIOCIGUAT 0.5 MG TABLET FOR CRUSH-DISSOLVE PARTIAL TABLET DOSES", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.31, "maximum": 4.56, "gross_charge": 5.7, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HYDROCHLOROTHIAZIDE 12.5 MG ORAL TAB/CAP (SO)", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.12, "maximum": 0.16, "gross_charge": 0.2, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HYDROCHLOROTHIAZIDE 6.25 MG SPLIT TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.32, "maximum": 0.44, "gross_charge": 0.55, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HYDROCHLOROTHIAZIDE 12.5 MG TABLET FOR CRUSH-DISSOLVE PARTIAL TABLET DOSES", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.12, "maximum": 0.16, "gross_charge": 0.2, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PENTOXIFYLLINE 400 MG EXTENDED RELEASE TABLET (PER TUBE ADMINISTRATION)", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.58, "maximum": 0.8, "gross_charge": 1.0, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HYDRALAZINE 10 MG TABLET FOR CRUSH-DISSOLVE PARTIAL TABLET DOSES", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.44, "maximum": 0.6, "gross_charge": 0.75, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "IVABRADINE 1 MG/ML ORAL SUSPENSION (SIMPLE)", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 7, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 22.16, "maximum": 366.36, "gross_charge": 38.2, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "IVABRADINE 1 MG/ML ORAL SUSPENSION (SIMPLE)", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 90, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 22.16, "maximum": 366.36, "gross_charge": 457.95, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 265.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 326.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 265.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 366.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 326.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MINOCYCLINE 50 MG CAPSULE", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.46, "maximum": 0.64, "gross_charge": 0.8, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MINOXIDIL 2.5 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.99, "maximum": 1.36, "gross_charge": 1.7, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MORPHINE 15 MG IMMEDIATE RELEASE TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.83, "maximum": 2.52, "gross_charge": 3.15, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "NADOLOL 40 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.6, "maximum": 2.2, "gross_charge": 2.75, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "NIFEDIPINE 10 MG CAPSULE", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.65, "maximum": 2.28, "gross_charge": 2.85, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "NITROFURANTOIN MACROCRYSTAL 25 MG CAPSULE", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 12.44, "maximum": 17.16, "gross_charge": 21.45, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 2.99, "maximum": 4.12, "gross_charge": 5.15, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "NITROGLYCERIN 0.3 MG SUBLINGUAL TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 8.0, "maximum": 11.04, "gross_charge": 13.8, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 2.06, "maximum": 2.84, "gross_charge": 3.55, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "NITROGLYCERIN 2 % TRANSDERMAL OINTMENT", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "GR"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.77, "maximum": 2.44, "gross_charge": 3.05, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "NORTRIPTYLINE 10 MG CAPSULE", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.15, "maximum": 0.2, "gross_charge": 0.25, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "NORTRIPTYLINE 25 MG CAPSULE", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.17, "maximum": 0.24, "gross_charge": 0.3, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 15, "type": "GR"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.8, "maximum": 5.24, "gross_charge": 6.55, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "NYSTATIN 100,000 UNIT/GRAM TOPICAL OINTMENT", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 15, "type": "GR"}, "standard_charges": [{"setting": "outpatient", "minimum": 11.17, "maximum": 15.4, "gross_charge": 19.25, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OXYBUTYNIN CHLORIDE 5 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.93, "maximum": 1.28, "gross_charge": 1.6, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.81, "maximum": 1.12, "gross_charge": 1.4, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PENICILLIN V POTASSIUM 250 MG/5 ML ORAL SOLUTION", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 200, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 25.67, "maximum": 35.4, "gross_charge": 44.25, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PENICILLIN V POTASSIUM 250 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.17, "maximum": 0.24, "gross_charge": 0.3, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PENICILLIN V POTASSIUM 500 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.23, "maximum": 0.32, "gross_charge": 0.4, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PHENAZOPYRIDINE 100 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.44, "maximum": 0.6, "gross_charge": 0.75, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PHENOBARBITAL 16.2 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.25, "maximum": 1.72, "gross_charge": 2.15, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PHENOBARBITAL 32.4 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.93, "maximum": 1.28, "gross_charge": 1.6, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PHENOBARBITAL 64.8 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.6, "maximum": 2.2, "gross_charge": 2.75, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PHENYLEPHRINE 2.5 % EYE DROPS", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 2, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 24.51, "maximum": 33.8, "gross_charge": 42.25, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PILOCARPINE 1 % EYE DROPS", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 15, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 25.46, "maximum": 35.12, "gross_charge": 43.9, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PILOCARPINE 2 % EYE DROPS", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 15, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 64.18, "maximum": 88.52, "gross_charge": 110.65, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 88.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PILOCARPINE 4 % EYE DROPS", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 15, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 67.28, "maximum": 92.8, "gross_charge": 116.0, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PRAZOSIN 1 MG CAPSULE", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.13, "maximum": 4.32, "gross_charge": 5.4, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PRAZOSIN 2 MG CAPSULE", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.1, "maximum": 4.28, "gross_charge": 5.35, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 21.84, "maximum": 30.12, "gross_charge": 37.65, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PROBENECID 500 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 4.29, "maximum": 5.92, "gross_charge": 7.4, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PROCHLORPERAZINE MALEATE 5 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 2.0, "maximum": 2.76, "gross_charge": 3.45, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PROMETHAZINE 25 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.32, "maximum": 0.44, "gross_charge": 0.55, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PROPARACAINE 0.5 % EYE DROPS", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 15, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 25.52, "maximum": 35.2, "gross_charge": 44.0, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PROPRANOLOL 40 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.04, "maximum": 1.44, "gross_charge": 1.8, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PROPYLTHIOURACIL 50 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 4.84, "maximum": 6.68, "gross_charge": 8.35, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PSEUDOEPHEDRINE 30 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.09, "maximum": 0.12, "gross_charge": 0.15, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PYRAZINAMIDE 500 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 9.6, "maximum": 13.24, "gross_charge": 16.55, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "RISPERIDONE 3 MG DISINTEGRATING TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 12.35, "maximum": 17.04, "gross_charge": 21.3, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.16, "maximum": 1.6, "gross_charge": 2.0, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ARIPIPRAZOLE 2 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.57, "maximum": 2.16, "gross_charge": 2.7, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ATENOLOL 25 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.38, "maximum": 0.52, "gross_charge": 0.65, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ATENOLOL 50 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.2, "maximum": 0.28, "gross_charge": 0.35, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SILVER SULFADIAZINE 1 % TOPICAL CREAM", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 400, "type": "GR"}, "standard_charges": [{"setting": "outpatient", "minimum": 42.11, "maximum": 58.08, "gross_charge": 72.6, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SODIUM BENZOATE (BULK) POWDER", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 500, "type": "GR"}, "standard_charges": [{"setting": "outpatient", "minimum": 10.88, "maximum": 15.0, "gross_charge": 18.75, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SODIUM CHLORIDE 3 % FOR NEBULIZATION", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 4, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.87, "maximum": 1.2, "gross_charge": 1.5, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SODIUM POLYSTYRENE SULFONATE 15 GRAM ORAL POWDER", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 454, "type": "GR"}, "standard_charges": [{"setting": "outpatient", "minimum": 145.38, "maximum": 200.52, "gross_charge": 250.65, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 145.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 200.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 178.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 145.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 178.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ATROPINE 1 % EYE DROPS", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 28.54, "maximum": 39.36, "gross_charge": 49.2, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SPIRONOLACTONE 25 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.29, "maximum": 0.4, "gross_charge": 0.5, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SPIRONOLACTONE 25 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.8, "maximum": 5.24, "gross_charge": 6.55, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.32, "maximum": 0.44, "gross_charge": 0.55, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SULFAMETHOXAZOLE 400 MG-TRIMETHOPRIM 80 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.46, "maximum": 0.64, "gross_charge": 0.8, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SULFASALAZINE 500 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.44, "maximum": 0.6, "gross_charge": 0.75, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "METHYLPHENIDATE 10 MG/9 HR DAILY TRANSDERMAL PATCH", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 12.79, "maximum": 17.64, "gross_charge": 22.05, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "METHYLPHENIDATE 15 MG/9 HR DAILY TRANSDERMAL PATCH", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 12.79, "maximum": 17.64, "gross_charge": 22.05, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "METHYLPHENIDATE 30 MG/9 HR DAILY TRANSDERMAL PATCH", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 12.79, "maximum": 17.64, "gross_charge": 22.05, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DASATINIB 20 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 283.33, "maximum": 390.8, "gross_charge": 488.5, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 283.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 390.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 348.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 283.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 348.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DASATINIB 50 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 472.21, "maximum": 651.32, "gross_charge": 814.15, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 580.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 472.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 651.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 580.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 472.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DASATINIB 70 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 472.21, "maximum": 651.32, "gross_charge": 814.15, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 472.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 651.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 580.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 472.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 580.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SODIUM HYPOCHLORITE 0.125 % SOLUTION", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 473, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 11.14, "maximum": 15.36, "gross_charge": 19.2, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CAFFEINE CITRATE 60 MG/3 ML (20 MG/ML) ORAL SOLUTION", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 120, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 3279.61, "maximum": 4523.6, "gross_charge": 5654.5, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3279.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4523.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4031.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3279.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4031.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PALIPERIDONE ER 3 MG TABLET,EXTENDED RELEASE 24 HR", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 19.37, "maximum": 26.72, "gross_charge": 33.4, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MESALAMINE 1.2 GRAM TABLET,DELAYED RELEASE", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 18.01, "maximum": 24.84, "gross_charge": 31.05, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TRAZODONE 50 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.26, "maximum": 0.36, "gross_charge": 0.45, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 15, "type": "GR"}, "standard_charges": [{"setting": "outpatient", "minimum": 2.15, "maximum": 2.96, "gross_charge": 3.7, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL OINTMENT", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 15, "type": "GR"}, "standard_charges": [{"setting": "outpatient", "minimum": 2.2, "maximum": 3.04, "gross_charge": 3.8, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TRIAZOLAM 0.25 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.63, "maximum": 5.0, "gross_charge": 6.25, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TRICHLOROACETIC ACID (BULK) CRYSTALS", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 500, "type": "GR"}, "standard_charges": [{"setting": "outpatient", "minimum": 122.53, "maximum": 169.0, "gross_charge": 211.25, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 150.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 122.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 169.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 150.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 122.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ACTIVATED CHARCOAL-SORBITOL 50 GRAM/240 ML ORAL SUSPENSION", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 240, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 52.64, "maximum": 72.6, "gross_charge": 90.75, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LISDEXAMFETAMINE 30 MG CAPSULE", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 13.98, "maximum": 19.28, "gross_charge": 24.1, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LISDEXAMFETAMINE 50 MG CAPSULE", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 27.43, "maximum": 37.84, "gross_charge": 47.3, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TRIHEXYPHENIDYL 2 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.35, "maximum": 0.48, "gross_charge": 0.6, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CEFIXIME 200 MG/5 ML ORAL SUSPENSION", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 240.29, "maximum": 331.44, "gross_charge": 414.3, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 240.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 331.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 295.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 240.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 295.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "QUETIAPINE ER 200 MG TABLET,EXTENDED RELEASE 24 HR", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 2.35, "maximum": 3.24, "gross_charge": 4.05, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SODIUM CHLORIDE 7 % FOR NEBULIZATION", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 4, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.42, "maximum": 1.96, "gross_charge": 2.45, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "AMBRISENTAN 5 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 71.28, "maximum": 98.32, "gross_charge": 122.9, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TROPICAMIDE 1 % EYE DROPS", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 15, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 5.51, "maximum": 7.6, "gross_charge": 9.5, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "VERAPAMIL 80 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.67, "maximum": 0.92, "gross_charge": 1.15, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "BACITRACIN-POLYMYXIN B 500 UNIT-10,000 UNIT/GRAM EYE OINTMENT", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 3, "type": "GR"}, "standard_charges": [{"setting": "outpatient", "minimum": 5.6, "maximum": 7.72, "gross_charge": 9.65, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "BACLOFEN 10 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.78, "maximum": 1.08, "gross_charge": 1.35, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DIAZEPAM 5 MG-7.5 MG-10 MG RECTAL KIT", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 402.26, "maximum": 554.84, "gross_charge": 693.55, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 402.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 554.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 494.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 402.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 494.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DIAZEPAM 12.5 MG-15 MG-17.5 MG-20 MG RECTAL KIT", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 224.72, "maximum": 309.96, "gross_charge": 387.45, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 276.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 224.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 309.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 276.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 224.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "POTASSIUM BICARBONATE-CITRIC ACID 20 MEQ EFFERVESCENT TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.19, "maximum": 1.64, "gross_charge": 2.05, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CHOLECALCIFEROL (VITAMIN D3) 1,250 MCG (50,000 UNIT) CAPSULE", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.32, "maximum": 0.44, "gross_charge": 0.55, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 8.32, "maximum": 11.48, "gross_charge": 14.35, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LISDEXAMFETAMINE 20 MG CAPSULE", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 27.43, "maximum": 37.84, "gross_charge": 47.3, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "AMINOCAPROIC ACID 500 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 23.0, "maximum": 31.72, "gross_charge": 39.65, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "AMIODARONE 200 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.52, "maximum": 0.72, "gross_charge": 0.9, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "AMLODIPINE 2.5 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.2, "maximum": 0.28, "gross_charge": 0.35, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "AMLODIPINE 5 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.17, "maximum": 0.24, "gross_charge": 0.3, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "AMOXICILLIN 250 MG-POTASSIUM CLAVULANATE 62.5 MG/5 ML ORAL SUSPENSION", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 150, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 118.76, "maximum": 163.8, "gross_charge": 204.75, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 118.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 163.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 145.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 118.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 145.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "APRACLONIDINE 0.5 % EYE DROPS", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 38.8, "maximum": 53.52, "gross_charge": 66.9, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DASATINIB 100 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 851.06, "maximum": 1173.88, "gross_charge": 1467.35, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 851.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1173.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1046.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 851.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1046.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "BROMOCRIPTINE 2.5 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 5.68, "maximum": 7.84, "gross_charge": 9.8, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "BUMETANIDE 0.5 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.73, "maximum": 1.0, "gross_charge": 1.25, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "BUSPIRONE 10 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.29, "maximum": 0.4, "gross_charge": 0.5, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CALCITRIOL 0.25 MCG CAPSULE", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.51, "maximum": 2.08, "gross_charge": 2.6, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CALCITRIOL 0.5 MCG CAPSULE", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.81, "maximum": 1.12, "gross_charge": 1.4, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CAPTOPRIL 12.5 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 2.67, "maximum": 3.68, "gross_charge": 4.6, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CAPTOPRIL 25 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 2.55, "maximum": 3.52, "gross_charge": 4.4, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CAPTOPRIL 50 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.57, "maximum": 2.16, "gross_charge": 2.7, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.44, "maximum": 0.6, "gross_charge": 0.75, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CEFADROXIL 500 MG CAPSULE", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.13, "maximum": 1.56, "gross_charge": 1.95, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CEPHALEXIN 250 MG CAPSULE", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.58, "maximum": 0.8, "gross_charge": 1.0, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CEPHALEXIN 500 MG CAPSULE", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.49, "maximum": 0.68, "gross_charge": 0.85, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "QUETIAPINE ER 50 MG TABLET,EXTENDED RELEASE 24 HR", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.62, "maximum": 2.24, "gross_charge": 2.8, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MESALAMINE ER 0.375 GRAM CAPSULE,EXTENDED RELEASE 24 HR", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 2.44, "maximum": 3.36, "gross_charge": 4.2, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "RUFINAMIDE 400 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 49.01, "maximum": 67.6, "gross_charge": 84.5, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CIPROFLOXACIN 0.3 % EYE DROPS", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 11.17, "maximum": 15.4, "gross_charge": 19.25, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CLARITHROMYCIN 250 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 4.26, "maximum": 5.88, "gross_charge": 7.35, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CLOBETASOL 0.05 % TOPICAL OINTMENT", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 30, "type": "GR"}, "standard_charges": [{"setting": "outpatient", "minimum": 6.35, "maximum": 8.76, "gross_charge": 10.95, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CLOTRIMAZOLE 10 MG TROCHE", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.67, "maximum": 0.92, "gross_charge": 1.15, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CLOZAPINE 100 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 2.44, "maximum": 3.36, "gross_charge": 4.2, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CLOZAPINE 25 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.9, "maximum": 1.24, "gross_charge": 1.55, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 30, "type": "GR"}, "standard_charges": [{"setting": "outpatient", "minimum": 235.97, "maximum": 325.48, "gross_charge": 406.85, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 235.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 325.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 290.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 235.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 290.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ARTEMETHER-LUMEFANTRINE 20 MG-120 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 11.92, "maximum": 16.44, "gross_charge": 20.55, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MESALAMINE 800 MG TABLET,DELAYED RELEASE", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 22.04, "maximum": 30.4, "gross_charge": 38.0, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LACOSAMIDE 50 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.26, "maximum": 0.36, "gross_charge": 0.45, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LACOSAMIDE 100 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 5.13, "maximum": 7.08, "gross_charge": 8.85, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CYCLOPENTOLATE 0.5 % EYE DROPS", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 15, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 76.88, "maximum": 106.04, "gross_charge": 132.55, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CYCLOPENTOLATE-PHENYLEPHRINE 0.2 %-1 % EYE DROPS", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 2, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 28.1, "maximum": 38.76, "gross_charge": 48.45, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DANTROLENE 25 MG CAPSULE", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 2.93, "maximum": 4.04, "gross_charge": 5.05, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "RISPERIDONE 0.25 MG DISINTEGRATING TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 6.79, "maximum": 9.36, "gross_charge": 11.7, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LIPASE-PROTEASE-AMYLASE(PORK)12,000-38,000-60,000 UNIT CAPSULE,DEL REL", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 910.14, "maximum": 1255.36, "gross_charge": 1569.2, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1118.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 910.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1255.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1118.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 910.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LIPASE-PROTEASE-AMYLAS(PORK)24,000-76,000-120,000 UNIT CAPSULE,DEL REL", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1804.26, "maximum": 2488.64, "gross_charge": 3110.8, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1804.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2488.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2218.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1804.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2218.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DOXAZOSIN 2 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.04, "maximum": 1.44, "gross_charge": 1.8, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DOXYCYCLINE MONOHYDRATE 25 MG/5 ML ORAL SUSPENSION", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 60, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 31.2, "maximum": 43.04, "gross_charge": 53.8, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ENALAPRIL MALEATE 5 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.32, "maximum": 0.44, "gross_charge": 0.55, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "VIGABATRIN 500 MG ORAL POWDER PACKET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 14.5, "maximum": 20.0, "gross_charge": 25.0, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LEVONORGESTREL 1.5 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 7.66, "maximum": 10.56, "gross_charge": 13.2, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 30, "type": "GR"}, "standard_charges": [{"setting": "outpatient", "minimum": 1160.99, "maximum": 1601.36, "gross_charge": 2001.7, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1160.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1601.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1427.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1160.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1427.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ETHACRYNIC ACID 25 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 4.87, "maximum": 6.72, "gross_charge": 8.4, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ETHAMBUTOL 100 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.7, "maximum": 0.96, "gross_charge": 1.2, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ETHAMBUTOL 400 MG TABLET", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.51, "maximum": 2.08, "gross_charge": 2.6, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.57, "maximum": 2.16, "gross_charge": 2.7, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "GUANFACINE ER 2 MG TABLET,EXTENDED RELEASE 24 HR", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.57, "maximum": 2.16, "gross_charge": 2.7, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ETHOSUXIMIDE 250 MG CAPSULE", "code_information": [{"code": "6370001", "type": "CDM"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 2.55, "maximum": 3.52, "gross_charge": 4.4, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LUTETIUM LU 177 DOTATATE 10 MCI/ML (370 MBQ/ML) INTRAVENOUS SOLUTION", "code_information": [{"code": "A9513", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 320.77, "maximum": 1056.89, "gross_charge": 988.9, "discounted_cash": 593.34, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 781.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 734.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 734.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 741.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 734.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1056.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 539.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 511.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 488.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 736.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 602.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 648.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 840.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 840.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 543.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 816.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 320.77, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 320.77, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 539.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 642.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 588.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 543.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 320.77, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 781.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 692.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 746.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 642.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 479.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 320.77, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 741.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 539.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 741.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 791.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 320.77, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 603.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 791.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1056.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 320.77, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 535.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 535.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 741.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 642.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 781.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 781.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 781.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 734.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 573.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 602.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 648.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 840.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 816.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 741.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 746.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 840.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 746.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 642.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 602.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 648.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 816.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 741.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 320.77, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 320.77, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 741.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 535.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 539.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 320.77, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 791.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 320.77, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 320.77, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 734.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 741.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 320.77, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 573.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 741.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FLORBETAPIR F-18 10 MCI (370 MBQ) INTRAVENOUS SOLUTION", "code_information": [{"code": "A9586", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1825.64, "maximum": 8831.42, "gross_charge": 10389.9, "discounted_cash": 6233.94, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8208.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 7719.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7719.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 7792.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7719.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7417.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5672.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5371.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5132.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7740.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6327.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6815.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 8831.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 8831.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5714.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8582.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1825.64, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1825.64, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5672.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 6753.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 6181.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 5714.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1825.64, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8208.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7272.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7844.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6753.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5039.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1825.64, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7792.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5672.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7792.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8311.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1825.64, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6337.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8311.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7417.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1825.64, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5631.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5631.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 7792.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6753.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8208.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8208.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8208.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7719.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6026.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6327.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6815.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 8831.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8582.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7792.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7844.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8831.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7844.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6753.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6327.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6815.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8582.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 7792.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1825.64, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1825.64, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7792.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5631.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5672.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1825.64, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8311.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1825.64, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1825.64, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7719.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7792.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1825.64, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6026.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7792.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "F-18 PYL-PYLARIFY (PIFLUFOLASTAT) INTRAVENOUS", "code_information": [{"code": "A9595", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 346.49, "maximum": 1320.09, "gross_charge": 1553.05, "discounted_cash": 931.83, "payers_information": [{"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1164.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1153.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1164.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 346.49, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 900.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 346.49, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1164.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 841.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 847.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 346.49, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1242.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 346.49, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 346.49, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1153.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1123.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1226.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 1153.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1153.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 1164.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 847.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 802.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 767.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1157.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 945.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1018.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1320.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 1320.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 854.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1282.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 346.49, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 346.49, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 1009.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 854.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 854.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 847.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 346.49, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1226.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1087.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1172.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1009.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 753.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 346.49, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1164.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1164.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1242.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 847.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 346.49, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 947.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1242.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1123.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 841.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 841.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1164.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1009.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 346.49, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1226.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 945.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1018.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 1320.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1282.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1226.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1153.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 900.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1226.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1164.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1172.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1320.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1172.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1009.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 945.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1018.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1282.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1164.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 346.49, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "F-18 PYL-PYLARIFY (PIFLUFOLASTAT) SYRINGE", "code_information": [{"code": "A9595", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 346.49, "maximum": 1472.03, "gross_charge": 1731.8, "discounted_cash": 1039.08, "payers_information": [{"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 346.49, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1298.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1054.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1136.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1430.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1307.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1125.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1472.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1307.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1298.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1368.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1368.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1286.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1004.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1054.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1136.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 1472.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1430.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1368.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 346.49, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1298.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1125.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 938.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 938.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1056.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1385.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1123.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 346.49, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 945.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1298.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1385.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1298.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 346.49, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1307.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1125.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 839.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1212.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1368.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 346.49, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 945.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 1125.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 952.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 952.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 346.49, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 346.49, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1054.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1136.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1472.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 1472.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 952.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1430.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1290.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 945.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 895.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 855.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1368.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 1286.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1286.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 1298.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1286.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1123.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 346.49, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 346.49, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1385.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 346.49, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 945.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 938.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1298.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 346.49, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1004.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 346.49, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1298.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1286.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1298.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "RADIUM RA 223 DICHLOR 1,100 KBQ/ML (30 MICROCURIE/ML) INTRAVENOUS SOLN", "code_information": [{"code": "A9606", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 171.92, "maximum": 580.62, "gross_charge": 523.25, "discounted_cash": 313.95, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 413.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 388.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 388.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 392.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 388.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 580.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 285.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 270.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 258.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 389.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 318.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 343.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 444.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 444.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 287.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 432.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 171.92, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 171.92, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 285.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 340.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 311.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 287.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 171.92, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 413.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 366.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 395.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 340.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 253.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 171.92, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 392.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 285.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 392.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 418.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 171.92, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 319.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 418.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 580.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 171.92, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 283.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 283.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 392.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 340.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 413.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 413.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 413.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 388.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 303.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 318.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 343.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 444.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 432.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 392.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 395.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 444.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 395.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 340.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 318.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 343.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 432.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 392.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 171.92, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 171.92, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 392.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 283.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 285.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 171.92, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 418.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 171.92, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 171.92, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 388.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 392.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 171.92, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 303.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 392.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LUTETIUM LU-177 VIPIVOTIDE TETRAXETAN 27 MCI/ML (1,000 MBQ/ML) IV SOLN", "code_information": [{"code": "A9607", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 51863.0, "maximum": 171150.0, "gross_charge": 150946.0, "discounted_cash": 90567.6, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 119247.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 112152.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 112152.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 113209.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 112152.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 171150.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82416.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78039.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 74567.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 112454.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91926.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 99020.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 128304.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 128304.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 83020.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 124681.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 51863.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 51863.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82416.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 98114.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 89812.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 83020.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 51863.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 119247.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 105662.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 113964.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 98114.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73208.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 51863.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 113209.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82416.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 113209.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 120756.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 51863.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 92077.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 120756.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 171150.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 51863.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 81812.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 81812.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 113209.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 98114.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 119247.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 119247.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 119247.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 112152.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 87548.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91926.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 99020.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 128304.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 124681.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 113209.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 113964.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 128304.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 113964.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 98114.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91926.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 99020.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 124681.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 113209.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 51863.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 51863.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 113209.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 81812.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82416.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 51863.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 120756.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 51863.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 51863.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 112152.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 113209.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 51863.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 87548.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 113209.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FLOTUFOLASTAT F 18 GALLIUM 296-5,846 MBQ/ML (8-158 MCI/ML) IV SOLUTION", "code_information": [{"code": "A9608", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 671.22, "maximum": 2268.72, "gross_charge": 2024.85, "discounted_cash": 1214.91, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1599.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 1504.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1504.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 1518.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1504.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2268.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1105.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1046.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1000.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1508.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1233.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1328.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1721.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 1721.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1113.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1672.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 671.22, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 671.22, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1105.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 1316.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1113.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 1113.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 671.22, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1599.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1417.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1528.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1316.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 982.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 671.22, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1518.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1105.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1518.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1619.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 671.22, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1235.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1619.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2268.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 671.22, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1097.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1097.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1518.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1316.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1599.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1599.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1599.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1504.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1174.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1233.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1328.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 1721.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1672.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1518.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1528.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1721.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1528.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1316.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1233.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1328.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1672.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1518.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 671.22, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 671.22, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1518.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1097.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1105.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 671.22, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1619.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 671.22, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 671.22, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1504.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1518.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 671.22, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1174.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1518.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "GALLIUM-68 GOZETOTIDE (GOZELLIX) 25 MCG INTRAVENOUS SOLUTION", "code_information": [{"code": "A9616", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 585650.0, "maximum": 1303900.0, "gross_charge": 1629875.0, "discounted_cash": 977925.0, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 814937.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 889911.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 842645.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 805158.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1214256.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 896431.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 585650.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 585650.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 889911.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 896431.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 585650.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 585650.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 889911.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1303900.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 585650.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1303900.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 814937.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 585650.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 883392.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1222406.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 945327.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1222406.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 585650.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 585650.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 883392.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 889911.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 585650.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1303900.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 585650.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 585650.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 585650.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 945327.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "GALLIUM-68 GOZETOTIDE (ILLUCCIX) 25 MCG INTRAVENOUS SOLUTION", "code_information": [{"code": "A9800", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 18125.0, "maximum": 147611.5, "gross_charge": 168919.1, "discounted_cash": 101351.46, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 147611.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 92229.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 87331.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 83446.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 125844.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 92905.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 18125.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 18125.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 92229.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 92905.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 18125.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 18125.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 92229.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 135135.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 18125.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 135135.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 147611.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 18125.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91554.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 126689.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 97973.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 126689.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 18125.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 18125.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91554.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 92229.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 18125.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 135135.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 18125.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 18125.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 18125.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 97973.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FAT EMULSION-SOYBEAN OIL-MCT-OLIVE OIL-FISH OIL 20 % INTRAVENOUS (SMOFLIPID)", "code_information": [{"code": "B4185", "type": "HCPCS"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.18, "maximum": 129.8, "gross_charge": 6.5, "discounted_cash": 3.9, "payers_information": [{"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FAT EMULSION-SOYBEAN OIL-MCT-OLIVE OIL-FISH OIL 20 % INTRAVENOUS (SMOFLIPID)", "code_information": [{"code": "B4185", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.18, "maximum": 129.8, "gross_charge": 64.7, "discounted_cash": 38.82, "payers_information": [{"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FAT EMULSION-SOYBEAN OIL-MCT-OLIVE OIL-FISH OIL 20 % INTRAVENOUS (SMOFLIPID)", "code_information": [{"code": "B4185", "type": "HCPCS"}], "drug_information": {"unit": 500, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.18, "maximum": 129.8, "gross_charge": 162.25, "discounted_cash": 97.35, "payers_information": [{"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 128.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 128.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 128.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 121.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 129.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 128.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 115.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 128.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 129.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 129.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 115.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 121.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FAT EMULSION-SOYBEAN OIL-MCT-OLIVE OIL-FISH OIL 20 % INTRAVENOUS (SMOFLIPID)", "code_information": [{"code": "B4185", "type": "HCPCS"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.18, "maximum": 129.8, "gross_charge": 12.95, "discounted_cash": 7.77, "payers_information": [{"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FAT EMULSION-SOYBEAN OIL-MCT-OLIVE OIL-FISH OIL 20 % INTRAVENOUS (SMOFLIPID)", "code_information": [{"code": "B4185", "type": "HCPCS"}], "drug_information": {"unit": 100, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.18, "maximum": 129.8, "gross_charge": 119.4, "discounted_cash": 71.64, "payers_information": [{"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 95.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 88.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 95.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 95.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FAT EMULSION-SOYBEAN OIL-MCT-OLIVE OIL-FISH OIL 20 % INTRAVENOUS (SMOFLIPID)", "code_information": [{"code": "B4185", "type": "HCPCS"}], "drug_information": {"unit": 15, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.18, "maximum": 129.8, "gross_charge": 19.45, "discounted_cash": 11.67, "payers_information": [{"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FAT EMULSION-SOYBEAN OIL-MCT-OLIVE OIL-FISH OIL 20 % INTRAVENOUS (SMOFLIPID)", "code_information": [{"code": "B4185", "type": "HCPCS"}], "drug_information": {"unit": 20, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.18, "maximum": 129.8, "gross_charge": 25.9, "discounted_cash": 15.54, "payers_information": [{"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FAT EMULSION-SOYBEAN OIL-MCT-OLIVE OIL-FISH OIL 20 % INTRAVENOUS (SMOFLIPID)", "code_information": [{"code": "B4185", "type": "HCPCS"}], "drug_information": {"unit": 25, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.18, "maximum": 129.8, "gross_charge": 32.35, "discounted_cash": 19.41, "payers_information": [{"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FAT EMULSION-SOYBEAN OIL-MCT-OLIVE OIL-FISH OIL 20 % INTRAVENOUS (SMOFLIPID)", "code_information": [{"code": "B4185", "type": "HCPCS"}], "drug_information": {"unit": 250, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.18, "maximum": 129.8, "gross_charge": 148.5, "discounted_cash": 89.1, "payers_information": [{"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 117.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 117.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 111.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 118.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 117.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 110.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 117.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 118.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 118.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 111.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 117.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FAT EMULSION-SOYBEAN OIL-MCT-OLIVE OIL-FISH OIL 20 % INTRAVENOUS (SMOFLIPID)", "code_information": [{"code": "B4185", "type": "HCPCS"}], "drug_information": {"unit": 30, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.18, "maximum": 129.8, "gross_charge": 38.85, "discounted_cash": 23.31, "payers_information": [{"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FAT EMULSION-SOYBEAN OIL-MCT-OLIVE OIL-FISH OIL 20 % INTRAVENOUS (SMOFLIPID)", "code_information": [{"code": "B4185", "type": "HCPCS"}], "drug_information": {"unit": 35, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.18, "maximum": 129.8, "gross_charge": 45.3, "discounted_cash": 27.18, "payers_information": [{"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FAT EMULSION-SOYBEAN OIL-MCT-OLIVE OIL-FISH OIL 20 % INTRAVENOUS (SMOFLIPID)", "code_information": [{"code": "B4185", "type": "HCPCS"}], "drug_information": {"unit": 40, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.18, "maximum": 129.8, "gross_charge": 51.75, "discounted_cash": 31.05, "payers_information": [{"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FAT EMULSION-SOYBEAN OIL-MCT-OLIVE OIL-FISH OIL 20 % INTRAVENOUS (SMOFLIPID)", "code_information": [{"code": "B4185", "type": "HCPCS"}], "drug_information": {"unit": 45, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.18, "maximum": 129.8, "gross_charge": 58.25, "discounted_cash": 34.95, "payers_information": [{"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OMEGAVEN 10% INFUSION", "code_information": [{"code": "B4187", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 54.95, "maximum": 241.56, "gross_charge": 301.95, "discounted_cash": 181.17, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 238.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 215.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 149.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 224.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 166.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 166.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 238.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 241.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 215.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 241.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 163.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 226.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 238.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 238.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 238.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 175.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 226.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 163.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 241.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 175.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OMEGAVEN 10% INFUSION SYRINGE", "code_information": [{"code": "B4187", "type": "HCPCS"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 5.61, "maximum": 208.36, "gross_charge": 61.6, "discounted_cash": 36.96, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OMEGAVEN 10% INFUSION SYRINGE", "code_information": [{"code": "B4187", "type": "HCPCS"}], "drug_information": {"unit": 15, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 5.61, "maximum": 208.36, "gross_charge": 85.25, "discounted_cash": 51.15, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OMEGAVEN 10% INFUSION SYRINGE", "code_information": [{"code": "B4187", "type": "HCPCS"}], "drug_information": {"unit": 20, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 5.61, "maximum": 208.36, "gross_charge": 113.65, "discounted_cash": 68.19, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OMEGAVEN 10% INFUSION SYRINGE", "code_information": [{"code": "B4187", "type": "HCPCS"}], "drug_information": {"unit": 25, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 5.61, "maximum": 208.36, "gross_charge": 142.05, "discounted_cash": 85.23, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 113.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 113.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 113.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OMEGAVEN 10% INFUSION SYRINGE", "code_information": [{"code": "B4187", "type": "HCPCS"}], "drug_information": {"unit": 30, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 5.61, "maximum": 208.36, "gross_charge": 156.3, "discounted_cash": 93.78, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 123.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 123.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 116.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 111.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 125.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 117.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 123.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 123.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 123.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 117.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 125.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 125.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 111.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OMEGAVEN 10% INFUSION SYRINGE", "code_information": [{"code": "B4187", "type": "HCPCS"}], "drug_information": {"unit": 35, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 5.61, "maximum": 208.36, "gross_charge": 182.3, "discounted_cash": 109.38, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 144.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 144.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 135.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 129.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 145.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 144.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 144.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 144.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 145.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 145.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 129.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OMEGAVEN 10% INFUSION SYRINGE", "code_information": [{"code": "B4187", "type": "HCPCS"}], "drug_information": {"unit": 40, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 5.61, "maximum": 208.36, "gross_charge": 208.35, "discounted_cash": 125.01, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 164.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 164.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 155.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 148.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 166.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 156.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 164.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 164.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 164.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 156.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 166.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 166.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 148.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OMEGAVEN 10% INFUSION SYRINGE", "code_information": [{"code": "B4187", "type": "HCPCS"}], "drug_information": {"unit": 45, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 5.61, "maximum": 208.36, "gross_charge": 234.4, "discounted_cash": 140.64, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 185.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 185.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 128.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 128.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 174.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 115.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 167.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 187.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 175.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 185.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 135.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 185.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 185.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 175.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 187.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 187.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 167.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 135.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OMEGAVEN 10% INFUSION SYRINGE", "code_information": [{"code": "B4187", "type": "HCPCS"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 5.61, "maximum": 208.36, "gross_charge": 30.8, "discounted_cash": 18.48, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OMEGAVEN 10% INFUSION SYRINGE", "code_information": [{"code": "B4187", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 5.61, "maximum": 208.36, "gross_charge": 260.45, "discounted_cash": 156.27, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 205.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 205.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 143.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 143.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 194.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 128.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 185.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 208.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 141.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 195.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 205.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 151.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 205.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 205.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 195.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 141.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 208.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 208.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 185.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 151.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LACOSAMIDE IV SYRINGE 10 MG/ML (PEDIATRICS)", "code_information": [{"code": "C9254", "type": "HCPCS"}], "drug_information": {"unit": 20, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 169.2, "maximum": 439.49, "gross_charge": 517.05, "discounted_cash": 310.23, "payers_information": [{"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 387.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 387.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 280.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 282.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 413.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 384.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 387.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 299.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 387.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 282.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 379.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 379.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 384.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 299.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 169.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 257.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 439.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 427.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 379.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 387.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 390.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 439.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 390.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 336.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 169.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 257.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 427.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 379.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 384.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 384.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 387.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 282.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 267.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 255.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 384.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 277.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 169.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 257.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 439.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 439.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 284.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 427.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 336.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 307.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 284.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 282.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 379.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 390.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 336.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 250.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 258.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 387.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 387.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 413.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 315.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 413.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 280.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 280.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 387.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 336.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LACOSAMIDE 200 MG/20 ML INTRAVENOUS SOLUTION", "code_information": [{"code": "C9254", "type": "HCPCS"}], "drug_information": {"unit": 20, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 32.74, "maximum": 257.88, "gross_charge": 67.5, "discounted_cash": 40.5, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 169.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 257.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 169.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 257.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 169.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 257.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "BEVACIZUMAB 25 MG/ML INTRAVENOUS SOLUTION FOR INTRAOCULAR USE", "code_information": [{"code": "C9257", "type": "HCPCS"}], "drug_information": {"unit": 4, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 736.4, "maximum": 5131.81, "gross_charge": 3306.25, "discounted_cash": 1983.75, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2423.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 2456.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2456.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 2479.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2456.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2476.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1805.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1709.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1633.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1772.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3367.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 5131.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 2810.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 2810.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1818.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2730.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 736.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 736.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1805.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 2446.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 2297.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 2149.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 736.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2423.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1653.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2496.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2149.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1603.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 736.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2479.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1805.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2479.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2645.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 736.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2479.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2645.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2476.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 736.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1791.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1791.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2479.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2149.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2423.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2423.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2423.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2456.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1917.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3367.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 5131.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 2810.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2730.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2479.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2496.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2810.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2496.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2149.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3367.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 5131.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2730.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2479.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 736.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 736.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2479.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1791.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1805.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 736.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2645.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 736.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 736.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2456.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2479.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 736.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1917.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2479.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "GLUCARPIDASE 1,000 UNIT INTRAVENOUS SOLUTION", "code_information": [{"code": "C9293", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 44869.1, "maximum": 155638.8, "gross_charge": 194548.5, "discounted_cash": 116729.1, "payers_information": [{"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 44869.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 44869.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 44869.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 44869.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 44869.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 155638.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 44869.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 112838.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 44869.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 44869.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 44869.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 44869.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 44869.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 44869.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 112838.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SOTALOL 150 MG/10 ML (15 MG/ML) INTRAVENOUS SOLUTION", "code_information": [{"code": "C9482", "type": "HCPCS"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 3763.5, "maximum": 23354.26, "gross_charge": 16303.5, "discounted_cash": 9782.1, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11950.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 12113.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 12113.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 12227.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 12113.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 12700.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8901.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8428.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8053.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8738.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 15323.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 23354.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 13857.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 13857.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 8966.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13466.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3763.5, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3763.5, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8901.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 10597.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 9700.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 8966.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3763.5, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11950.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8151.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12309.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10597.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7907.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3763.5, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12227.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8901.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12227.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13042.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3763.5, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9945.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13042.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 12700.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3763.5, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8836.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8836.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 12227.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10597.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11950.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11950.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11950.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 12113.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 9456.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 15323.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 23354.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 13857.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13466.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12227.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12309.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13857.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12309.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10597.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 15323.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 23354.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13466.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 12227.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3763.5, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3763.5, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12227.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8836.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8901.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3763.5, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13042.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3763.5, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3763.5, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 12113.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12227.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3763.5, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 9456.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12227.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ABATACEPT (WITH MALTOSE) 250 MG INTRAVENOUS SOLUTION", "code_information": [{"code": "J0129", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1119.23, "maximum": 7215.8, "gross_charge": 6730.9, "discounted_cash": 4038.54, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4933.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 5001.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5001.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 5048.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5001.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3759.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3675.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3479.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3325.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3607.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4734.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 7215.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 5721.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5721.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3702.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5559.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1119.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1119.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3675.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 4980.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4677.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 4375.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1119.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4933.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1930.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5081.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4375.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1119.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5048.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3675.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5048.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5384.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1119.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5048.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5384.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3759.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1119.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3648.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3648.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 5048.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4375.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4933.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4933.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4933.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5001.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3903.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4734.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 7215.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5721.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5559.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5048.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5081.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5721.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5081.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4375.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4734.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 7215.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5559.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 5048.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1119.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1119.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5048.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3648.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3675.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1119.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5384.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1119.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1119.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5001.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5048.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1119.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3903.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5048.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ACETYLCYSTEINE 200 MG/ML (20 %) INTRAVENOUS SOLUTION", "code_information": [{"code": "J0132", "type": "HCPCS"}], "drug_information": {"unit": 30, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 55.97, "maximum": 143.12, "gross_charge": 115.4, "discounted_cash": 69.24, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 75.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 93.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 143.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 95.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 75.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 93.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 143.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 95.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 93.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 143.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 95.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION", "code_information": [{"code": "J0133", "type": "HCPCS"}], "drug_information": {"unit": 20, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 20.0, "maximum": 154.73, "gross_charge": 115.2, "discounted_cash": 69.12, "payers_information": [{"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 101.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 154.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 97.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 95.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 97.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 101.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 154.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 95.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 20.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 20.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 101.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 154.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 97.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 97.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 95.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "J0133", "type": "HCPCS"}], "drug_information": {"unit": 20, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 63.36, "maximum": 74.88, "gross_charge": 115.2, "discounted_cash": 69.12, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ACYCLOVIR IV SYRINGE 5 MG/ML (PEDIATRICS)", "code_information": [{"code": "J0133", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.61, "maximum": 38.68, "gross_charge": 7.45, "discounted_cash": 4.47, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 25.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 38.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 25.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 38.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 25.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 38.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ACYCLOVIR IV SYRINGE 5 MG/ML (PEDIATRICS)|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "J0133", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 4.1, "maximum": 4.84, "gross_charge": 7.45, "discounted_cash": 4.47, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ACYCLOVIR IV SYRINGE 5 MG/ML (NON-STANDARD) (PEDIATRICS)", "code_information": [{"code": "J0133", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.61, "maximum": 38.68, "gross_charge": 7.45, "discounted_cash": 4.47, "payers_information": [{"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 25.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 38.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 25.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 38.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 25.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 38.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ACYCLOVIR IV SYRINGE 5 MG/ML (NON-STANDARD) (PEDIATRICS)|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "J0133", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 4.1, "maximum": 4.84, "gross_charge": 7.45, "discounted_cash": 4.47, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) INTRAVENOUS SOLUTION", "code_information": [{"code": "J0134", "type": "HCPCS"}], "drug_information": {"unit": 100, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 16.68, "maximum": 38.68, "gross_charge": 34.4, "discounted_cash": 20.64, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 20.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 25.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 38.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 20.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 25.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 38.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 25.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 38.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ADALIMUMAB 40 MG/0.4 ML SUBCUTANEOUS PEN KIT", "code_information": [{"code": "J0139", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 2583.63, "maximum": 12402.0, "gross_charge": 14195.75, "discounted_cash": 8517.45, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10405.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 12402.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7012.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7608.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7807.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2924.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2583.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 7807.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10405.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7097.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11356.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11356.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 12402.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3321.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7694.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 10646.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10405.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10405.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10405.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 8233.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 10646.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3321.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3321.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7694.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3321.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11356.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 8233.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ADENOSINE (DIAGNOSTIC) 3 MG/ML INTRAVENOUS SOLUTION", "code_information": [{"code": "J0153", "type": "HCPCS"}], "drug_information": {"unit": 30, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 42.44, "maximum": 307.52, "gross_charge": 87.5, "discounted_cash": 52.5, "payers_information": [{"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 139.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 201.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 307.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 201.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 307.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 139.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 201.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 307.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ADENOSINE 3 MG/ML INTRAVENOUS SOLUTION (SO)", "code_information": [{"code": "J0153", "type": "HCPCS"}], "drug_information": {"unit": 2, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 5.21, "maximum": 20.5, "gross_charge": 10.75, "discounted_cash": 6.45, "payers_information": [{"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 13.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 20.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 13.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 20.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 13.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 20.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "EPINEPHRINE (JR) 0.15 MG/0.3 ML INJECTION,AUTO-INJECTOR", "code_information": [{"code": "J0165", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.64, "maximum": 526.11, "gross_charge": 618.95, "discounted_cash": 371.37, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 453.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 459.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 459.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 464.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 459.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 337.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 320.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 305.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 331.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 526.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 526.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 340.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 511.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 458.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 430.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 402.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 337.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 453.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 467.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 402.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 300.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 309.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 464.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 464.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 495.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 464.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 495.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 335.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 335.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 464.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 402.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 337.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 453.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 453.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 459.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 358.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 526.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 511.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 453.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 464.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 467.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 526.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 511.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 467.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 402.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 464.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 464.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 335.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 337.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 495.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 459.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 464.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 464.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 358.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "EPINEPHRINE (JR) 0.15 MG/0.3 ML INJECTION,AUTO-INJECTOR|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "J0165", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.82, "maximum": 402.32, "gross_charge": 618.95, "discounted_cash": 371.37, "payers_information": [{"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 377.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 402.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 340.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 340.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "EPINEPHRINE 0.3 MG/0.3 ML INJECTION, AUTO-INJECTOR", "code_information": [{"code": "J0165", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 5.46, "maximum": 526.11, "gross_charge": 618.95, "discounted_cash": 371.37, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 459.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 453.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 459.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 459.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 464.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 526.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 526.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 340.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 511.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 331.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 337.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 320.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 305.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 458.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 430.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 402.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 467.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 402.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 300.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 453.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 337.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 464.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 495.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 464.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 495.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 464.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 309.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 526.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 511.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 526.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 467.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 464.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 453.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 453.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 459.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 358.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 453.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 337.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 464.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 402.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 335.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 335.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 511.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 464.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 464.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 467.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 402.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 464.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 459.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 495.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 337.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 335.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 358.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 464.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "EPINEPHRINE 0.3 MG/0.3 ML INJECTION, AUTO-INJECTOR|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "J0165", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 340.42, "maximum": 402.32, "gross_charge": 618.95, "discounted_cash": 371.37, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 377.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 402.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 340.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 340.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "EPINEPHRINE 1 MG/ML INJECTION SOLUTION (SO)", "code_information": [{"code": "J0166", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 23.57, "maximum": 771.0, "gross_charge": 48.6, "discounted_cash": 29.16, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 77.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 46.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 71.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 77.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 46.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 71.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 46.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 71.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "EPINEPHRINE 1 MG/ML INJECTION SOLUTION (SO)", "code_information": [{"code": "J0166", "type": "HCPCS"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 23.57, "maximum": 771.0, "gross_charge": 240.2, "discounted_cash": 144.12, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 178.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 771.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 131.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 124.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 118.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 469.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 715.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 204.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 204.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 132.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 198.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 177.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 166.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 156.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 128.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 131.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 176.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 181.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 156.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 116.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 180.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 131.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 180.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 192.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 176.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 178.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 178.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 180.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 180.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 192.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 771.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 130.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 130.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 180.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 156.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 176.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 178.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 139.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 469.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 715.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 204.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 198.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 176.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 176.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 180.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 181.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 469.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 715.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 198.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 181.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 156.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 204.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 180.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 180.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 130.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 131.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 192.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 178.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 180.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 139.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 180.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "EPINEPHRINE 1 MG/ML INJECTION SOLUTION (SO) (ENDOTRACHEAL) - PED NARRATORS", "code_information": [{"code": "J0166", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 23.57, "maximum": 77.1, "gross_charge": 48.6, "discounted_cash": 29.16, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 46.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 71.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 77.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 46.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 71.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 46.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 71.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 77.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "EPINEPHRINE HCL 50 MCG/5 ML(10 MCG/ML)IN 0.9 % SOD.CHLORIDE IV SYRINGE", "code_information": [{"code": "J0169", "type": "HCPCS"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 4.46, "maximum": 34.6, "gross_charge": 40.7, "discounted_cash": 24.42, "payers_information": [{"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "EPINEPHRINE HCL 200 MCG/10 ML(20 MCG/ML) IN 0.9 % SOD CHLOR IV SYRINGE", "code_information": [{"code": "J0169", "type": "HCPCS"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 4.1, "maximum": 17.79, "gross_charge": 8.45, "discounted_cash": 5.07, "payers_information": [{"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 17.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 17.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 17.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "EPINEPHRINE HCL 500 MCG/10 ML (50 MCG/ML) IN 0.9% SODIUM CHLORIDE", "code_information": [{"code": "J0169", "type": "HCPCS"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 9.36, "maximum": 44.48, "gross_charge": 19.3, "discounted_cash": 11.58, "payers_information": [{"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 29.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 44.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 22.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 29.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 44.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 22.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 29.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 44.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "EPINEPHRINE 5 MCG/ML INJECTION SOLUTION", "code_information": [{"code": "J0169", "type": "HCPCS"}], "drug_information": {"unit": 30, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 8.85, "maximum": 17.79, "gross_charge": 18.25, "discounted_cash": 10.95, "payers_information": [{"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 17.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 17.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 17.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "EPINEPHRINE 5 MCG/ML INJECTION SOLUTION|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "J0169", "type": "HCPCS"}], "drug_information": {"unit": 30, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 4.44, "maximum": 8.9, "gross_charge": 9.15, "discounted_cash": 5.49, "payers_information": [{"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "EPINEPHRINE INFUSION 20 MCG/ML IN D5 (PEDIATRICS)", "code_information": [{"code": "J0169", "type": "HCPCS"}], "drug_information": {"unit": 20, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 7.93, "maximum": 35.59, "gross_charge": 16.35, "discounted_cash": 9.81, "payers_information": [{"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 23.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 35.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 23.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 35.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 17.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 23.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 35.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 17.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "EPINEPHRINE 1 MG/ML (1 ML) INJECTION SOLUTIONS (PAR PHARMACEUTICALS)", "code_information": [{"code": "J0169", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 22.19, "maximum": 88.97, "gross_charge": 45.75, "discounted_cash": 27.45, "payers_information": [{"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 44.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 58.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 88.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 44.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 58.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 88.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 58.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 88.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "EPINEPHRINE INFUSION 20 MCG/ML IN NS (PEDIATRICS)", "code_information": [{"code": "J0169", "type": "HCPCS"}], "drug_information": {"unit": 20, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 7.93, "maximum": 35.59, "gross_charge": 16.35, "discounted_cash": 9.81, "payers_information": [{"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 23.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 35.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 23.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 35.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 17.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 23.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 35.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 17.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "EPINEPHRINE INFUSION 120 MCG/ML IN NS (PEDIATRICS)", "code_information": [{"code": "J0169", "type": "HCPCS"}], "drug_information": {"unit": 20, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 27.48, "maximum": 213.52, "gross_charge": 56.65, "discounted_cash": 33.99, "payers_information": [{"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 107.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 140.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 213.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 107.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 140.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 213.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 140.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 213.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "EPINEPHRINE INFUSION 40 MCG/ML IN NS (PEDIATRICS)", "code_information": [{"code": "J0169", "type": "HCPCS"}], "drug_information": {"unit": 20, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 12.61, "maximum": 71.17, "gross_charge": 26.0, "discounted_cash": 15.6, "payers_information": [{"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 46.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 71.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 46.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 71.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 35.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 46.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 71.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 35.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "EPINEPHRINE INFUSION 40 MCG/ML IN D5 (PEDIATRICS)", "code_information": [{"code": "J0169", "type": "HCPCS"}], "drug_information": {"unit": 20, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 12.61, "maximum": 71.17, "gross_charge": 26.0, "discounted_cash": 15.6, "payers_information": [{"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 35.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 46.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 71.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 35.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 46.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 71.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 46.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 71.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "AGALSIDASE BETA 35 MG INTRAVENOUS SOLUTION", "code_information": [{"code": "J0180", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 8061.17, "maximum": 51970.56, "gross_charge": 31018.3, "discounted_cash": 18610.98, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 17990.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 8061.17, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 8061.17, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23263.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16811.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "fee schedule", "standard_charge_dollar": 9883.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 8061.17, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24814.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 8061.17, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 8061.17, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 23046.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23263.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 8061.17, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22736.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22736.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22736.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 23046.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 17990.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 34098.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 51970.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 26365.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25621.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23263.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23418.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23418.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20161.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 34098.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 51970.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25621.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26365.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 23263.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22736.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 23046.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 23046.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 23263.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 23046.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 27239.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "fee schedule", "standard_charge_dollar": 9883.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "fee schedule", "standard_charge_dollar": 9883.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "fee schedule", "standard_charge_dollar": 9883.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 34098.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 51970.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 26365.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 26365.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 17060.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25621.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 8061.17, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 8061.17, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16625.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "fee schedule", "standard_charge_dollar": 9883.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 20161.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 17060.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 17060.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 8061.17, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22736.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23418.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20161.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15043.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 9838.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 8061.17, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23263.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "fee schedule", "standard_charge_dollar": 9883.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23263.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24814.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23263.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24814.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 27239.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 8061.17, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 8061.17, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16811.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16811.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 23263.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20161.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23263.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "AGALSIDASE BETA 5 MG INTRAVENOUS SOLUTION", "code_information": [{"code": "J0180", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1151.6, "maximum": 7424.37, "gross_charge": 4791.55, "discounted_cash": 2874.93, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2779.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3593.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3593.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3114.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2597.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2597.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1151.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1151.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3593.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3833.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3891.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3593.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3833.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "fee schedule", "standard_charge_dollar": 1411.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3593.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1151.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1405.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3617.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3114.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2323.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3512.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1151.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 3114.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 2635.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 2635.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "fee schedule", "standard_charge_dollar": 1411.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2568.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1151.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1151.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4871.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 7424.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4072.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4072.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2635.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3957.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "fee schedule", "standard_charge_dollar": 1411.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "fee schedule", "standard_charge_dollar": 1411.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1411.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3560.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3891.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3512.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 3560.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3560.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 3593.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3593.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4072.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4871.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 7424.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3957.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3617.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3114.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3617.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3593.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4871.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 7424.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4072.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3957.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3512.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3560.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2779.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3512.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3512.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1151.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3593.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3560.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1151.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1151.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3833.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1151.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "fee schedule", "standard_charge_dollar": 1411.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2597.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3593.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1151.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1151.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SODIUM THIOSULFATE 12.5 GRAM/50 ML (250 MG/ML) INTRAVENOUS SOLUTION", "code_information": [{"code": "J0209", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 110.25, "maximum": 441.79, "gross_charge": 519.75, "discounted_cash": 311.85, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 380.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 386.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 386.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 389.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 386.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 392.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 283.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 268.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 256.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 278.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 316.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 340.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 441.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 441.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 285.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 429.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 110.25, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 110.25, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 283.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 384.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 361.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 337.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 110.25, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 380.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 259.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 392.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 337.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 252.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 110.25, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 389.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 283.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 389.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 415.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 110.25, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 389.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 415.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 392.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 110.25, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 281.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 281.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 389.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 337.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 380.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 380.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 380.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 386.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 301.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 316.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 340.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 441.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 429.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 389.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 392.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 441.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 392.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 337.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 316.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 340.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 429.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 389.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 110.25, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 110.25, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 389.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 281.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 283.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 110.25, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 415.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 110.25, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 110.25, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 386.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 389.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 110.25, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 301.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 389.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN", "code_information": [{"code": "J0211", "type": "HCPCS"}], "drug_information": {"unit": 60, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 216.6, "maximum": 748.56, "gross_charge": 935.7, "discounted_cash": 561.42, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 733.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 216.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 216.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 216.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 216.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 216.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 748.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 733.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 216.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 542.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 216.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 216.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 216.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 216.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 216.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 216.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 542.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "AVALGLUCOSIDASE ALFA-NGPT 100 MG INTRAVENOUS SOLUTION", "code_information": [{"code": "J0219", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 2032.4, "maximum": 13103.53, "gross_charge": 8182.35, "discounted_cash": 4909.41, "payers_information": [{"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2032.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5997.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2448.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6177.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5318.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3968.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2032.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6136.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "fee schedule", "standard_charge_dollar": 2482.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6136.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6545.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2032.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4991.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6545.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6823.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5997.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 6079.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 6079.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 6136.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 6079.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6823.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "fee schedule", "standard_charge_dollar": 2482.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "fee schedule", "standard_charge_dollar": 2482.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "fee schedule", "standard_charge_dollar": 2482.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4385.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8597.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 13103.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 6955.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 6955.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4500.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6758.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2032.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2032.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "fee schedule", "standard_charge_dollar": 2482.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 5318.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4868.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 4500.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2032.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4434.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4434.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 6136.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5318.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5997.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5997.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5997.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 6079.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4745.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8597.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 13103.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 6955.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6758.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6136.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6177.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6955.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6177.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5318.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8597.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 13103.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6758.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 6136.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2032.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2032.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6136.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4434.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "fee schedule", "standard_charge_dollar": 2482.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2032.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6545.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2032.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2032.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 6079.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6136.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2032.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4745.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6136.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "AVALGLUCOSIDASE ALFA-NGPT 100 MG INTRAVENOUS SOLUTION|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "J0219", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 5318.53, "maximum": 6136.76, "gross_charge": 8182.35, "discounted_cash": 4909.41, "payers_information": [{"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 6054.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 5686.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 5318.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6136.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ALGLUCOSIDASE ALFA 50 MG INTRAVENOUS SOLUTION", "code_information": [{"code": "J0221", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1036.93, "maximum": 6685.22, "gross_charge": 4339.95, "discounted_cash": 2603.97, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3181.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 3224.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3224.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 3254.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3224.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3491.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "fee schedule", "standard_charge_dollar": 1267.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "fee schedule", "standard_charge_dollar": 1267.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1267.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2326.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4386.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 6685.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 3688.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 3688.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2386.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3584.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1036.93, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1036.93, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "fee schedule", "standard_charge_dollar": 1267.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 2820.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 2386.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 2386.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1036.93, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3181.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1273.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3276.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2820.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2104.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1036.93, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3254.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "fee schedule", "standard_charge_dollar": 1267.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3254.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3471.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1036.93, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3471.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3491.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1036.93, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2352.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2352.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3254.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2820.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3181.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3181.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3181.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3224.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2517.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4386.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 6685.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 3688.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3584.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3254.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3276.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3688.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3276.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2820.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4386.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 6685.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3584.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3254.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1036.93, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1036.93, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3254.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2352.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "fee schedule", "standard_charge_dollar": 1267.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1036.93, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3471.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1036.93, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1036.93, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3224.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3254.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1036.93, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2517.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3254.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "REMDESIVIR 100 MG INTRAVENOUS POWDER FOR SOLUTION", "code_information": [{"code": "J0248", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 689.8, "maximum": 4448.43, "gross_charge": 2928.25, "discounted_cash": 1756.95, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2146.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 2175.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2175.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 2196.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2175.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2275.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1598.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1513.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1446.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1569.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2918.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 4448.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 2489.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 2489.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1610.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2418.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 689.8, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 689.8, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1598.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 2166.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 2035.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 1903.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 689.8, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2146.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1464.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2210.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1903.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1420.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 689.8, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2196.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1598.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2196.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2342.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 689.8, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2196.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2342.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2275.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 689.8, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1587.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1587.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2196.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1903.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2146.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2146.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2146.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2175.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1698.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2918.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 4448.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 2489.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2418.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2196.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2210.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2489.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2210.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1903.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2918.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 4448.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2418.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2196.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 689.8, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 689.8, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2196.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1587.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1598.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 689.8, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2342.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 689.8, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 689.8, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2175.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2196.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 689.8, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1698.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2196.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "AMIKACIN 1,000 MG/4 ML INJECTION SOLUTION", "code_information": [{"code": "J0278", "type": "HCPCS"}], "drug_information": {"unit": 4, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 12.59, "maximum": 39.97, "gross_charge": 25.95, "discounted_cash": 15.57, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 21.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 26.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 39.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 21.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 26.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 39.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 26.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 39.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "AMIKACIN 1,000 MG/4 ML INJECTION SOLUTION|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "J0278", "type": "HCPCS"}], "drug_information": {"unit": 4, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 15.83, "maximum": 15.83, "gross_charge": 25.95, "discounted_cash": 15.57, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "AMIKACIN IV SYRINGE 5 MG/ML (PEDIATRICS)", "code_information": [{"code": "J0278", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 6.3, "maximum": 15.6, "gross_charge": 18.35, "discounted_cash": 11.01, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 11.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 11.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 11.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "AMIKACIN IV SYRINGE 5 MG/ML (PEDIATRICS)|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "J0278", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 4.2, "maximum": 10.41, "gross_charge": 12.25, "discounted_cash": 7.35, "payers_information": [{"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "AMIKACIN IVPB 5 MG/ML (PEDIATRICS)", "code_information": [{"code": "J0278", "type": "HCPCS"}], "drug_information": {"unit": 100, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 10.5, "maximum": 61.88, "gross_charge": 72.8, "discounted_cash": 43.68, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 13.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 19.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 13.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 19.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 13.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 19.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "AMIKACIN IVPB 5 MG/ML (PEDIATRICS)|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "J0278", "type": "HCPCS"}], "drug_information": {"unit": 100, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 44.41, "maximum": 44.41, "gross_charge": 72.8, "discounted_cash": 43.68, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "AMIKACIN IV SYRINGE 5 MG/ML (NON-STANDARD) (PEDIATRICS)", "code_information": [{"code": "J0278", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 6.3, "maximum": 961.69, "gross_charge": 1131.4, "discounted_cash": 678.84, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 829.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 840.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 840.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 848.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 840.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 905.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 848.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 617.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 848.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 905.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 606.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 617.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 829.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 565.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 854.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 735.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 548.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 11.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 961.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 961.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 622.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 934.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 617.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 584.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 558.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 735.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 622.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 622.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 613.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 613.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 848.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 735.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 829.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 840.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 656.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 11.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 961.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 934.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 829.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 829.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 848.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 854.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 11.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 934.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 854.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 735.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 961.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 848.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 848.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 613.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 617.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 905.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 840.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 848.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 656.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 848.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "AMIKACIN IV SYRINGE 5 MG/ML (NON-STANDARD) (PEDIATRICS)|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "J0278", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 4.2, "maximum": 641.16, "gross_charge": 754.3, "discounted_cash": 452.58, "payers_information": [{"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 565.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 437.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 565.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 560.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 603.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 411.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 408.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 565.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 565.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 641.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 569.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 490.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 623.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 569.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 565.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 552.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 552.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 641.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 623.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 552.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 560.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 437.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 565.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 490.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 408.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 408.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 490.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 414.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 414.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 411.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 389.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 372.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 641.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 641.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 414.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 623.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 569.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 490.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 365.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 377.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 552.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 411.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 404.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 565.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 603.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 411.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 565.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 460.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 603.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 560.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 552.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 560.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 560.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 565.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "AMIKACIN IVPB 5 MG/ML (NON-STANDARD) (PEDIATRICS)", "code_information": [{"code": "J0278", "type": "HCPCS"}], "drug_information": {"unit": 100, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 4.58, "maximum": 19.99, "gross_charge": 9.45, "discounted_cash": 5.67, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 13.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 19.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 13.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 19.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 13.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 19.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "AMIKACIN IVPB 5 MG/ML (NON-STANDARD) (PEDIATRICS)|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "J0278", "type": "HCPCS"}], "drug_information": {"unit": 100, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 5.76, "maximum": 5.76, "gross_charge": 9.45, "discounted_cash": 5.67, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "AMINOPHYLLINE 500 MG/20 ML INTRAVENOUS SOLUTION", "code_information": [{"code": "J0280", "type": "HCPCS"}], "drug_information": {"unit": 20, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 23.16, "maximum": 134.23, "gross_charge": 47.75, "discounted_cash": 28.65, "payers_information": [{"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 88.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 134.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 88.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 134.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 56.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 88.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 134.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 56.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "AMINOPHYLLINE 250 MG/10 ML INTRAVENOUS SOLUTION", "code_information": [{"code": "J0280", "type": "HCPCS"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 28.05, "maximum": 67.11, "gross_charge": 68.3, "discounted_cash": 40.98, "payers_information": [{"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 44.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 67.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 44.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 67.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 44.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 67.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 28.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 28.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "AMINOCAPROIC ACID 250 MG/ML INTRAVENOUS SOLUTION", "code_information": [{"code": "J0281", "type": "HCPCS"}], "drug_information": {"unit": 20, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 24.51, "maximum": 33.8, "gross_charge": 42.25, "discounted_cash": 25.35, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 25.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 25.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "AMIODARONE INFUSION 1.8 MG/ML (PEDIATRICS)", "code_information": [{"code": "J0282", "type": "HCPCS"}], "drug_information": {"unit": 20, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.44, "maximum": 10.63, "gross_charge": 12.5, "discounted_cash": 7.5, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "AMIODARONE INFUSION 1.8 MG/ML (PEDIATRICS)|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "J0282", "type": "HCPCS"}], "drug_information": {"unit": 20, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.72, "maximum": 2.64, "gross_charge": 12.5, "discounted_cash": 7.5, "payers_information": [{"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "AMIODARONE 50 MG/ML INJECTION SOLUTION (SO)", "code_information": [{"code": "J0282", "type": "HCPCS"}], "drug_information": {"unit": 3, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 8.6, "maximum": 22.27, "gross_charge": 26.2, "discounted_cash": 15.72, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 13.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 13.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 13.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "AMIODARONE IV SYRINGE 1.8 MG/ML (PEDIATRICS)", "code_information": [{"code": "J0282", "type": "HCPCS"}], "drug_information": {"unit": 200, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 20.64, "maximum": 93.88, "gross_charge": 110.45, "discounted_cash": 66.27, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 88.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 31.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 88.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 31.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 20.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 31.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 88.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 20.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "AMIODARONE IV SYRINGE 1.8 MG/ML (PEDIATRICS)|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "J0282", "type": "HCPCS"}], "drug_information": {"unit": 200, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 20.64, "maximum": 93.84, "gross_charge": 110.4, "discounted_cash": 66.24, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 88.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 20.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 31.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 20.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 31.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 88.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 31.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 88.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "AMIODARONE 360 MG/200 ML (1.8 MG/ML) IN DEXTROSE, ISO-OSMOTIC IV", "code_information": [{"code": "J0283", "type": "HCPCS"}], "drug_information": {"unit": 200, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 53.54, "maximum": 195.73, "gross_charge": 110.4, "discounted_cash": 66.24, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 105.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 128.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 195.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 88.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 88.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 105.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 128.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 195.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 128.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 195.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 88.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "AMPHOTERICIN B 50 MG SOLUTION FOR INJECTION", "code_information": [{"code": "J0285", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 92.61, "maximum": 279.09, "gross_charge": 190.95, "discounted_cash": 114.57, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 139.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 141.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 141.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 143.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 141.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 115.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 183.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 279.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 162.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 162.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 157.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 124.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 113.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 139.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 95.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 144.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 124.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 143.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 143.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 152.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 116.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 152.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 115.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 143.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 124.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 139.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 139.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 139.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 141.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 110.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 183.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 279.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 162.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 157.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 143.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 144.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 162.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 144.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 124.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 183.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 279.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 157.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 143.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 143.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 152.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 141.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 143.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 110.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 143.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "AMPHOTERICIN B LIPOSOME 50 MG INTRAVENOUS SUSPENSION", "code_information": [{"code": "J0289", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 103.61, "maximum": 667.91, "gross_charge": 463.5, "discounted_cash": 278.1, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 268.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 347.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 339.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 344.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 344.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 347.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 344.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 382.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 253.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 239.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 228.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 438.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 667.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 393.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 393.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 254.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 382.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 103.61, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 103.61, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 248.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 253.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 301.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 275.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 254.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 103.61, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 339.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 349.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 301.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 224.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 231.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 103.61, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 347.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 253.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 347.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 370.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 282.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 370.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 382.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 103.61, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 103.61, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 251.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 251.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 347.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 301.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 339.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 339.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 339.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 344.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 268.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 438.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 667.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 393.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 382.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 347.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 349.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 349.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 301.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 438.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 667.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 382.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 393.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 347.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 103.61, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 103.61, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 347.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 251.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 253.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 103.61, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 370.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 103.61, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 103.61, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 344.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 347.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 103.61, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "AMPHOTERICIN B LIPOSOME INHALED 4 MG/ML (PEDIATRIC)", "code_information": [{"code": "J0289", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 103.61, "maximum": 393.98, "gross_charge": 463.5, "discounted_cash": 278.1, "payers_information": [{"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 347.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 393.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 282.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 304.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 382.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 349.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 301.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 349.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 347.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 282.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 304.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 393.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 382.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 366.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 344.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 268.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 366.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 366.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 103.61, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 370.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 103.61, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 253.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 251.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 347.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 103.61, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 103.61, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 366.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 344.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 344.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 347.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 347.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 301.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 251.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 251.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 103.61, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 103.61, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 282.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 370.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 330.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 347.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 370.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 253.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 347.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 103.61, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 349.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 301.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 224.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 366.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 103.61, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 301.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 275.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 254.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 253.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 345.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 103.61, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 103.61, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 282.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 304.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 393.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 393.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 254.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 382.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 253.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 239.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 228.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 344.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 330.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 103.61, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 347.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 344.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 103.61, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 347.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 268.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "AMPICILLIN 1 GRAM (100 MG/ML) SOLUTION FOR INJECTION-IV", "code_information": [{"code": "J0290", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.32, "maximum": 7.86, "gross_charge": 9.25, "discounted_cash": 5.55, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "AMPICILLIN 10 GRAM (100 MG/ML) SOLUTION FOR INJECTION- IV", "code_information": [{"code": "J0290", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 33.2, "maximum": 88.66, "gross_charge": 104.3, "discounted_cash": 62.58, "payers_information": [{"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 49.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 76.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 49.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 76.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 88.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 88.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 33.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 49.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 76.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 88.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 88.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 33.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "AMPICILLIN 250 MG (100MG/ML) SOLUTION FOR INJECTION- IV", "code_information": [{"code": "J0290", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.66, "maximum": 3.8, "gross_charge": 3.9, "discounted_cash": 2.34, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "AMPICILLIN 500 MG (100 MG/ML) SOLUTION FOR INJECTION- IV", "code_information": [{"code": "J0290", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.66, "maximum": 4.08, "gross_charge": 4.8, "discounted_cash": 2.88, "payers_information": [{"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "AMPICILLIN IV SYRINGE 30 MG/ML (PEDIATRICS)", "code_information": [{"code": "J0290", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 4.98, "maximum": 14.37, "gross_charge": 16.9, "discounted_cash": 10.14, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 11.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 11.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 11.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "AMPICILLIN IVPB 30 MG/ML (PEDIATRICS)", "code_information": [{"code": "J0290", "type": "HCPCS"}], "drug_information": {"unit": 100, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 9.96, "maximum": 28.73, "gross_charge": 33.8, "discounted_cash": 20.28, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 9.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 9.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 14.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 22.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 14.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 22.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 14.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 22.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "AMPICILLIN IV SYRINGE 100 MG/ML (PEDIATRICS)", "code_information": [{"code": "J0290", "type": "HCPCS"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.32, "maximum": 9.65, "gross_charge": 11.35, "discounted_cash": 6.81, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "AMPICILLIN 1 GRAM (250MG/ML) SOLUTION FOR INJECTION- IM", "code_information": [{"code": "J0290", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.32, "maximum": 24.61, "gross_charge": 28.95, "discounted_cash": 17.37, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "AMPICILLIN 10 GRAM (250MG/ML) SOLUTION FOR INJECTION- IM", "code_information": [{"code": "J0290", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 50.59, "maximum": 88.66, "gross_charge": 104.3, "discounted_cash": 62.58, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 88.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 88.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 88.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 88.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "AMPICILLIN 250 MG (250MG/ML) SOLUTION FOR INJECTION- IM", "code_information": [{"code": "J0290", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.66, "maximum": 3.8, "gross_charge": 3.9, "discounted_cash": 2.34, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "AMPICILLIN 500 MG (250MG/ML) SOLUTION FOR INJECTION- IM", "code_information": [{"code": "J0290", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.66, "maximum": 4.08, "gross_charge": 4.8, "discounted_cash": 2.88, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "AMPICILLIN-SULBACTAM 15 GRAM SOLUTION FOR INJECTION", "code_information": [{"code": "J0295", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 50.4, "maximum": 102.64, "gross_charge": 120.75, "discounted_cash": 72.45, "payers_information": [{"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 96.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 96.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 50.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 88.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 56.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 85.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 88.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 88.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 56.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 85.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 96.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 88.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 50.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 56.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 85.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 88.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "AMPICILLIN-SULBACTAM IV SYRINGE 30 MG/ML (PEDIATRICS)", "code_information": [{"code": "J0295", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 8.2, "maximum": 17.15, "gross_charge": 16.9, "discounted_cash": 10.14, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 17.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 10.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 17.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 17.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 10.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "AMPICILLIN-SULBACTAM IV SYRINGE 30 MG/ML (PEDIATRICS)|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "J0295", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 5.04, "maximum": 8.57, "gross_charge": 16.9, "discounted_cash": 10.14, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "AMPICILLIN-SULBACTAM IVPB 30 MG/ML (PEDIATRICS)", "code_information": [{"code": "J0295", "type": "HCPCS"}], "drug_information": {"unit": 100, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 15.12, "maximum": 28.73, "gross_charge": 33.8, "discounted_cash": 20.28, "payers_information": [{"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 16.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 25.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 16.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 25.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 15.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 16.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 25.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 15.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION", "code_information": [{"code": "J0295", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 10.08, "maximum": 18.66, "gross_charge": 21.95, "discounted_cash": 13.17, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 10.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 17.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 17.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 10.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 17.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJECTION SOLUTION", "code_information": [{"code": "J0330", "type": "HCPCS"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 15.86, "maximum": 54.8, "gross_charge": 32.7, "discounted_cash": 19.62, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 52.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 35.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 54.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 52.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 35.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 54.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 35.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 54.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HYDRALAZINE 20 MG/ML INJECTION SOLUTION", "code_information": [{"code": "J0360", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 9.41, "maximum": 28.3, "gross_charge": 19.4, "discounted_cash": 11.64, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 18.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 28.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 18.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 28.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 17.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 18.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 28.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 17.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HYDRALAZINE IV SYRINGE 1 MG/ML (PEDIATRICS)", "code_information": [{"code": "J0360", "type": "HCPCS"}], "drug_information": {"unit": 20, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 10.04, "maximum": 28.3, "gross_charge": 20.7, "discounted_cash": 12.42, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 18.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 28.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 18.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 28.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 17.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 18.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 28.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 17.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HYDRALAZINE 20 MG/ML INJECTION SOLUTION (PEDIATRICS)", "code_information": [{"code": "J0360", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 9.41, "maximum": 28.3, "gross_charge": 19.4, "discounted_cash": 11.64, "payers_information": [{"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 17.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 18.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 28.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 17.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 18.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 28.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 18.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 28.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ARTESUNATE 110 MG INTRAVENOUS SOLUTION", "code_information": [{"code": "J0391", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 5701.19, "maximum": 19270.9, "gross_charge": 21625.65, "discounted_cash": 12975.39, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15851.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 19270.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10683.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11591.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 11894.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5701.19, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5701.19, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 11894.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5701.19, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15851.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10812.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5701.19, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17300.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5701.19, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17300.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 19270.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5701.19, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11721.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 16219.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15851.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15851.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15851.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 12542.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 16219.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5701.19, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5701.19, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11721.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5701.19, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17300.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5701.19, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5701.19, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5701.19, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 12542.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION", "code_information": [{"code": "J0456", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 8.44, "maximum": 14.79, "gross_charge": 17.4, "discounted_cash": 10.44, "payers_information": [{"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 13.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 13.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 13.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "AZITHROMYCIN IV SYRINGE 2 MG/ML (PEDIATRICS)", "code_information": [{"code": "J0456", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.7, "maximum": 13.15, "gross_charge": 3.5, "discounted_cash": 2.1, "payers_information": [{"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 13.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 13.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 13.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "AZITHROMYCIN IVPB 2 MG/ML (PEDIATRICS)", "code_information": [{"code": "J0456", "type": "HCPCS"}], "drug_information": {"unit": 100, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.47, "maximum": 13.15, "gross_charge": 7.15, "discounted_cash": 4.29, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 13.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 13.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 13.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "AZITHROMYCIN IV SYRINGE 2 MG/ML (NON-STANDARD) (PEDIATRICS)", "code_information": [{"code": "J0456", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.7, "maximum": 13.15, "gross_charge": 3.5, "discounted_cash": 2.1, "payers_information": [{"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 13.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 13.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 13.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "AZITHROMYCIN IVPB 2 MG/ML (NON-STANDARD) (PEDIATRICS)", "code_information": [{"code": "J0456", "type": "HCPCS"}], "drug_information": {"unit": 100, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.4, "maximum": 13.15, "gross_charge": 7.0, "discounted_cash": 4.2, "payers_information": [{"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 13.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 13.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 13.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "AZTREONAM IV SYRINGE 50 MG/ML (PEDIATRICS)", "code_information": [{"code": "J0457", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 137.52, "maximum": 359.42, "gross_charge": 283.55, "discounted_cash": 170.13, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 207.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 210.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 210.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 212.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 210.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 225.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 151.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 154.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 146.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 140.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 207.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 235.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 359.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 241.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 234.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 153.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 153.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 212.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 184.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 154.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 207.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 207.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 210.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 164.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 235.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 359.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 241.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 241.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 155.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 234.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 184.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 155.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 155.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 154.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 207.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 214.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 184.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 137.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 141.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 212.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 212.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 226.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 172.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 226.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 225.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 212.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 214.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 214.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 184.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 235.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 359.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 234.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 241.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 212.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 212.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 153.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 154.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 226.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 210.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 212.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 164.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 212.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "AZTREONAM 2 GRAM SOLUTION FOR INJECTION", "code_information": [{"code": "J0457", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 109.97, "maximum": 287.54, "gross_charge": 226.75, "discounted_cash": 136.05, "payers_information": [{"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 121.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 123.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 117.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 168.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 180.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 166.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 168.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 168.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 170.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 166.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 188.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 287.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 192.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 166.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 168.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 131.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 166.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 123.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 170.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 147.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 122.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 122.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 138.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 181.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 180.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 170.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 181.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 170.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 113.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 171.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 147.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 109.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 166.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 123.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 147.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 124.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 124.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 188.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 287.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 192.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 192.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 124.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 187.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 170.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 131.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 170.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 168.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 181.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 123.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 122.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 170.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 170.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 192.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 171.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 170.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 188.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 287.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 187.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 171.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 147.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 187.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ATROPINE 0.4 MG/ML INJECTION SOLUTION (ENDOTRACHEAL) - PED NARRATORS", "code_information": [{"code": "J0462", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 12.66, "maximum": 33.52, "gross_charge": 26.1, "discounted_cash": 15.66, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 22.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 33.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 22.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 33.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 22.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 33.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ATROPINE 0.4 MG/ML INJECTION SOLUTION", "code_information": [{"code": "J0462", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 12.66, "maximum": 33.52, "gross_charge": 26.1, "discounted_cash": 15.66, "payers_information": [{"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 22.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 33.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 22.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 33.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 22.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 33.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "BACLOFEN 10,000 MCG/20 ML (500 MCG/ML) INTRATHECAL SYRINGE", "code_information": [{"code": "J0475", "type": "HCPCS"}], "drug_information": {"unit": 20, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 181.47, "maximum": 1169.94, "gross_charge": 847.9, "discounted_cash": 508.74, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 491.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 635.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 640.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 551.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 720.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 635.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 181.47, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 181.47, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 635.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 459.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 462.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 181.47, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 678.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 181.47, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 181.47, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 629.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 635.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 181.47, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 621.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 629.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 629.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 635.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 462.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 438.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 418.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 767.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1169.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 720.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 720.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 466.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 700.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 629.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 594.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 181.47, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 181.47, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 551.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 504.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 466.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 454.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 462.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 181.47, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 621.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 640.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 551.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 411.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 423.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 181.47, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 635.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 462.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 517.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 678.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 594.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 635.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 678.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 181.47, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 181.47, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 459.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 459.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 635.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 551.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 621.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 629.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 491.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 767.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1169.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 720.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 700.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 621.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 621.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 635.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 640.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 767.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1169.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 700.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "BACLOFEN 20,000 MCG/20 ML (1,000 MCG/ML) INTRATHECAL SYRINGE", "code_information": [{"code": "J0475", "type": "HCPCS"}], "drug_information": {"unit": 20, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 362.93, "maximum": 2339.87, "gross_charge": 1495.6, "discounted_cash": 897.36, "payers_information": [{"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1535.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 2339.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1235.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1129.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1121.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1096.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1096.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1535.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 2339.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 1271.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1235.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1096.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1111.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 867.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1121.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 972.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 810.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 810.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 362.93, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 362.93, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1121.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1196.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 912.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1196.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1188.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 816.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1121.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 362.93, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 747.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1129.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 972.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 725.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1096.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 362.93, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 816.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 801.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 972.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 889.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 822.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 362.93, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 362.93, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1111.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1188.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1535.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 2339.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1271.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 1271.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 822.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1235.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 816.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 773.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 738.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1096.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 1111.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1111.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 1121.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 362.93, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1121.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1111.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 362.93, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 362.93, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1196.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 362.93, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 816.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 810.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1121.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 362.93, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 362.93, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1121.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1271.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1129.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 972.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1121.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 867.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "BACLOFEN 40,000 MCG/20 ML (2,000 MCG/ML) INTRATHECAL SYRINGE", "code_information": [{"code": "J0475", "type": "HCPCS"}], "drug_information": {"unit": 20, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 725.86, "maximum": 4679.75, "gross_charge": 2813.45, "discounted_cash": 1688.07, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1631.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2110.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2124.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1828.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2391.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2110.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 725.86, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 725.86, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2110.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1524.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1536.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 725.86, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2250.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 725.86, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 725.86, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2090.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2110.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 725.86, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2062.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 2090.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2090.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 2110.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1536.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1454.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1389.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3070.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 4679.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 2391.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 2391.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1547.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2323.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2090.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2377.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 725.86, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 725.86, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 1828.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1674.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 1547.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1508.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1536.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 725.86, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2062.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2124.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1828.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1364.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1406.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 725.86, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2110.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1536.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1716.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2250.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2377.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2110.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2250.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 725.86, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 725.86, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1524.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1524.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2110.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1828.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2062.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2090.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1631.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3070.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 4679.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 2391.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2323.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2062.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2062.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2110.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2124.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3070.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 4679.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2323.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "BACLOFEN 50 MCG/ML (1 ML) INTRATHECAL SYRINGE", "code_information": [{"code": "J0476", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 204.82, "maximum": 383.66, "gross_charge": 422.3, "discounted_cash": 253.38, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 309.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 313.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 313.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 316.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 313.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 227.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 230.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 218.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 208.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 226.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 251.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 383.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 358.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 358.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 232.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 348.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 230.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 274.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 232.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 232.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 309.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 211.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 318.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 274.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 204.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 316.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 230.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 316.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 337.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 337.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 227.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 228.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 228.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 316.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 274.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 309.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 309.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 309.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 313.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 244.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 251.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 383.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 358.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 348.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 316.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 318.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 358.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 318.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 274.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 251.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 383.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 348.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 316.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 316.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 228.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 230.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 337.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 313.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 316.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 244.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 316.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "BASILIXIMAB 20 MG INTRAVENOUS SOLUTION", "code_information": [{"code": "J0480", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 4781.07, "maximum": 30823.56, "gross_charge": 20194.2, "discounted_cash": 12116.52, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14802.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 15004.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 15004.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 15145.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 15004.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 15792.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11026.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10440.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9975.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10824.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 20223.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 30823.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 17165.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 17165.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 11106.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16680.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 4781.07, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 4781.07, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11026.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 14943.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 14034.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 13126.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 4781.07, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14802.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10097.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15246.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13126.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9794.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 4781.07, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15145.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11026.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15145.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16155.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 4781.07, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15145.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16155.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 15792.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 4781.07, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10945.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10945.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 15145.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13126.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14802.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14802.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14802.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 15004.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 11712.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 20223.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 30823.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 17165.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16680.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15145.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15246.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17165.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15246.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13126.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 20223.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 30823.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16680.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 15145.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 4781.07, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 4781.07, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15145.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10945.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11026.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 4781.07, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16155.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 4781.07, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 4781.07, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 15004.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15145.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 4781.07, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 11712.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15145.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "BELIMUMAB 120 MG INTRAVENOUS SOLUTION", "code_information": [{"code": "J0490", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 685.87, "maximum": 4422.13, "gross_charge": 3037.0, "discounted_cash": 1822.2, "payers_information": [{"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2292.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1974.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2901.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 4422.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2508.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2581.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2277.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 685.87, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 685.87, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2277.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1646.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1658.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 685.87, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2429.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 685.87, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 685.87, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2256.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2277.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 685.87, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2277.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1761.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2226.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 2256.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2256.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 2277.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2256.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2271.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2901.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 4422.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 2581.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 2581.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1670.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2508.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1658.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1570.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1500.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 685.87, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 685.87, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1627.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1658.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 1974.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1670.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 1670.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 685.87, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2226.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2292.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1974.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1472.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 821.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 685.87, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2277.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1658.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2277.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2429.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2277.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2429.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2271.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 685.87, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 685.87, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1646.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1646.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2277.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1974.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2226.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2226.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2901.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 4422.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 2581.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2508.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2226.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2256.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1761.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2277.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2292.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "BELIMUMAB 400 MG INTRAVENOUS SOLUTION", "code_information": [{"code": "J0490", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 2286.24, "maximum": 14740.42, "gross_charge": 10122.45, "discounted_cash": 6073.47, "payers_information": [{"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7642.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7591.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7419.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7520.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 5871.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 9671.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 14740.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 8604.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8361.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7419.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7419.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 7591.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6579.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5486.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5486.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2286.24, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2286.24, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7591.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8097.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7572.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7591.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8097.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5526.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7591.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2286.24, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2738.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7642.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6579.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4909.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7419.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2286.24, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 6579.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 5567.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 5567.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5526.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5425.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2286.24, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2286.24, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5526.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5233.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5000.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 9671.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 14740.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 8604.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 8604.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5567.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8361.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7520.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7572.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7419.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 7520.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7520.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 7591.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 5871.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7591.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2286.24, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7591.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7520.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2286.24, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2286.24, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8097.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2286.24, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5526.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5486.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7591.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2286.24, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2286.24, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 7591.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8604.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 9671.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 14740.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8361.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7642.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6579.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "BENZTROPINE 1 MG/ML INJECTION SOLUTION (PEDIATRICS)", "code_information": [{"code": "J0515", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 32.48, "maximum": 58.37, "gross_charge": 65.75, "discounted_cash": 39.45, "payers_information": [{"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 58.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 58.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "BENZTROPINE 1 MG/ML INJECTION SOLUTION", "code_information": [{"code": "J0515", "type": "HCPCS"}], "drug_information": {"unit": 2, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 64.94, "maximum": 116.74, "gross_charge": 131.45, "discounted_cash": 78.87, "payers_information": [{"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 116.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 96.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 116.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 96.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 96.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 96.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 96.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PENICILLIN G BENZATHINE 1,200,000 UNIT/2 ML INTRAMUSCULAR SYRINGE", "code_information": [{"code": "J0561", "type": "HCPCS"}], "drug_information": {"unit": 2, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 383.58, "maximum": 2473.33, "gross_charge": 1434.1, "discounted_cash": 860.46, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1051.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 1065.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1065.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 1075.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1065.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1188.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 783.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 741.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 708.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 768.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1622.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 2473.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1218.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 1218.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 788.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1184.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 383.58, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 383.58, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 783.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 932.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 788.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 788.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 383.58, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1051.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 717.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1082.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 932.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 695.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 383.58, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1075.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 783.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1075.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1147.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 383.58, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 874.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1147.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1188.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 383.58, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 777.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 777.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1075.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 932.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1051.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1051.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1051.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1065.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 831.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1622.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 2473.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 1218.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1184.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1075.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1082.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1218.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1082.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 932.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1622.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 2473.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1184.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1075.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 383.58, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 383.58, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1075.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 777.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 783.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 383.58, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1147.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 383.58, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 383.58, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1065.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1075.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 383.58, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 831.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1075.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CERLIPONASE ALFA 150 MG/5 ML INTRAVENTRICULAR SOLUTION", "code_information": [{"code": "J0567", "type": "HCPCS"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 36359.1, "maximum": 226753.88, "gross_charge": 143905.5, "discounted_cash": 86343.3, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 105482.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 106921.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 106921.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 107929.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 106921.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 141231.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "fee schedule", "standard_charge_dollar": 44016.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "fee schedule", "standard_charge_dollar": 44016.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "fee schedule", "standard_charge_dollar": 44016.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 148777.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 226753.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 122319.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 122319.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 79148.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 118865.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77133.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 36359.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 36359.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 106490.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 100014.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 93538.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "fee schedule", "standard_charge_dollar": 44016.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 36359.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 105482.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71952.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 108648.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 93538.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 69794.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 36359.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 107929.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 107929.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 115124.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "fee schedule", "standard_charge_dollar": 44016.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 36359.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 107929.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 115124.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 141231.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77996.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77996.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 107929.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 93538.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 36359.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 105482.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 105482.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 106921.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 83465.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 148777.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 226753.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 122319.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 118865.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 105482.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 107929.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 108648.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 122319.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 108648.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 93538.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 148777.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 226753.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 118865.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 107929.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 36359.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 36359.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 107929.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77996.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "fee schedule", "standard_charge_dollar": 44016.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 36359.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 115124.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 107929.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 36359.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 36359.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 106921.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 107929.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 36359.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 83465.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CERLIPONASE ALFA 300 MG/10 ML(150 MG/5ML X2) INTRAVENTRICULAR KIT", "code_information": [{"code": "J0567", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 36359.1, "maximum": 226753.88, "gross_charge": 158269.5, "discounted_cash": 94961.7, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 91796.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 36359.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 118702.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 117594.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 36359.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 36359.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 118702.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 126615.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 36359.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "fee schedule", "standard_charge_dollar": 44016.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 85782.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 118702.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 36359.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 36359.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 118702.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 148777.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 226753.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 130730.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 119493.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 102875.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 134529.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 119493.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 118702.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 116011.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 148777.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 226753.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 134529.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 130730.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 116011.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 117594.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 91796.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 116011.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 36359.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 118702.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 102875.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 85782.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 85782.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 118702.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 126615.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 141231.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 36359.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "fee schedule", "standard_charge_dollar": 44016.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 118702.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 126615.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 118702.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 36359.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 119493.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 102875.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 76760.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79134.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 116011.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 36359.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "fee schedule", "standard_charge_dollar": 44016.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 117119.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 109997.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 102875.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 36359.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 36359.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 84832.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 148777.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 226753.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 134529.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 134529.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 87048.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 130730.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "fee schedule", "standard_charge_dollar": 44016.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "fee schedule", "standard_charge_dollar": 44016.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "fee schedule", "standard_charge_dollar": 44016.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 117594.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 141231.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 116011.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 117594.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 117594.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 118702.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "BIVALIRUDIN 250 MG INTRAVENOUS POWDER FOR SOLUTION", "code_information": [{"code": "J0583", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 95.57, "maximum": 257.88, "gross_charge": 197.05, "discounted_cash": 118.23, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 144.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 146.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 146.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 147.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 146.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 142.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 107.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 97.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 169.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 257.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 167.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 167.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 162.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 107.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 128.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 144.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 148.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 128.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 95.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 147.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 107.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 147.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 157.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 157.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 142.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 147.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 128.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 144.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 144.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 144.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 146.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 169.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 257.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 167.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 162.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 147.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 148.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 167.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 148.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 128.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 169.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 257.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 162.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 147.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 147.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 107.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 157.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 146.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 147.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 147.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ONABOTULINUMTOXINA 100 UNIT SOLUTION FOR INJECTION", "code_information": [{"code": "J0585", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 651.0, "maximum": 4197.0, "gross_charge": 2929.5, "discounted_cash": 1757.7, "payers_information": [{"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 651.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 651.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1587.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1587.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2197.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1904.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2147.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2147.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2147.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 2176.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2176.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 2197.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2176.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2197.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2753.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 4197.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 2490.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 2490.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1611.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2419.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1599.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1514.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1447.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 651.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 651.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1570.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1599.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 2167.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 2036.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 1904.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 651.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2147.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2211.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1904.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1420.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 852.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 651.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2197.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1599.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2197.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2343.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2197.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2343.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2197.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2197.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2176.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2197.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 651.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1699.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2211.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2490.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2211.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1904.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2753.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 4197.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2419.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2197.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 651.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 651.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2197.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1587.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1599.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 651.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2343.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 651.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 651.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2753.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 4197.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 2490.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2419.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2197.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2147.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2176.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1699.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ONABOTULINUMTOXINA 100 UNIT SOLUTION FOR INJECTION (100 UNIT/ML)", "code_information": [{"code": "J0585", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 651.0, "maximum": 4197.0, "gross_charge": 2929.5, "discounted_cash": 1757.7, "payers_information": [{"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2197.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2753.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 4197.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 2490.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2419.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 651.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 651.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2343.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 651.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1599.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1587.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2197.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 651.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 651.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2197.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2753.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 4197.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2419.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2211.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1904.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2490.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2211.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1699.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 651.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2197.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2176.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2197.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1699.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2147.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2147.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2197.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1904.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1587.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1587.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 651.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 651.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2197.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2343.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2197.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2197.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2343.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1599.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2197.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 651.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 852.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2211.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1904.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1420.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2147.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 651.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 2167.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 2036.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 1904.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1599.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1570.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 651.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 651.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1599.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1514.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1447.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2753.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 4197.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 2490.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 2490.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1611.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2419.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2176.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2197.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2147.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 2176.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2176.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 2197.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2147.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2176.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ABOBOTULINUMTOXINA 300 UNIT INTRAMUSCULAR SOLUTION", "code_information": [{"code": "J0586", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 527.94, "maximum": 3404.02, "gross_charge": 2218.1, "discounted_cash": 1330.86, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1625.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 1648.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1648.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 1663.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1648.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1859.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1211.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1146.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1095.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1188.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2233.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 3404.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1885.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 1885.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1219.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1832.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 527.94, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 527.94, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1211.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 1641.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1541.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 1441.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 527.94, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1625.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 680.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1674.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1441.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1075.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 527.94, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1663.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1211.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1663.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1774.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 527.94, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1663.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1774.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1859.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 527.94, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1202.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1202.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1663.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1441.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1625.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1625.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1625.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1648.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1286.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2233.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 3404.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 1885.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1832.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1663.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1674.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1885.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1674.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1441.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2233.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 3404.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1832.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1663.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 527.94, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 527.94, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1663.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1202.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1211.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 527.94, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1774.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 527.94, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 527.94, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1648.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1663.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 527.94, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1286.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1663.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "RIMABOTULINUMTOXINB 5,000 UNIT/ML INTRAMUSCULAR SOLUTION", "code_information": [{"code": "J0587", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 664.45, "maximum": 2254.5, "gross_charge": 2699.1, "discounted_cash": 1619.46, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2254.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 664.45, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 664.45, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 664.45, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 821.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 664.45, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 664.45, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2159.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2254.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 664.45, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1565.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 664.45, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 664.45, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 664.45, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 664.45, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 664.45, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 664.45, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1565.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "INCOBOTULINUMTOXINA 100 UNIT INTRAMUSCULAR SOLUTION", "code_information": [{"code": "J0588", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 525.4, "maximum": 3384.68, "gross_charge": 2299.5, "discounted_cash": 1379.7, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1685.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 1708.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1708.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 1724.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1708.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1795.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1255.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1188.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1135.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1232.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2220.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 3384.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1954.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 1954.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1264.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1899.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 525.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 525.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1255.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 1701.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1598.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 1494.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 525.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1685.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 707.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1736.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1494.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1115.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 525.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1724.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1255.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1724.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1839.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 525.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1724.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1839.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1795.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 525.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1246.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1246.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1724.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1494.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1685.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1685.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1685.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1708.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1333.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2220.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 3384.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 1954.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1899.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1724.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1736.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1954.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1736.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1494.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2220.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 3384.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1899.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1724.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 525.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 525.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1724.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1246.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1255.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 525.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1839.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 525.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 525.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1708.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1724.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 525.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1333.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1724.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "BUSULFAN 60 MG/10 ML INTRAVENOUS SOLUTION", "code_information": [{"code": "J0594", "type": "HCPCS"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 53.52, "maximum": 373.2, "gross_charge": 176.65, "discounted_cash": 105.99, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 129.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 131.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 131.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 132.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 131.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 373.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 96.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 225.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 344.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 150.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 150.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 97.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 145.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 53.52, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 53.52, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 96.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 130.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 122.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 53.52, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 129.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 88.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 133.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 53.52, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 132.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 96.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 132.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 141.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 53.52, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 132.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 141.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 373.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 53.52, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 95.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 95.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 132.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 129.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 129.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 129.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 131.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 225.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 344.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 150.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 145.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 132.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 133.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 150.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 133.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 225.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 344.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 145.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 132.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 53.52, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 53.52, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 132.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 95.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 96.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 53.52, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 141.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 53.52, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 53.52, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 131.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 132.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 53.52, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 132.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS SOLUTION", "code_information": [{"code": "J0597", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 3793.0, "maximum": 13704.24, "gross_charge": 17130.3, "discounted_cash": 10278.18, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 12820.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3793.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3793.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3793.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3793.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3793.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13704.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 12820.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3793.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 9935.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3793.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3793.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3793.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3793.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3793.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3793.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 9935.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "C1 ESTERASE INHIBITOR 500 UNIT (5 ML) INTRAVENOUS SOLUTION", "code_information": [{"code": "J0598", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 3281.5, "maximum": 11229.8, "gross_charge": 14037.25, "discounted_cash": 8422.35, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11108.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3281.5, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3281.5, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3281.5, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4098.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3281.5, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3281.5, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11229.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11108.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3281.5, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 8141.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3281.5, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3281.5, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3281.5, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3281.5, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3281.5, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3281.5, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 8141.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "EDETATE CALCIUM DISODIUM 200 MG/ML INJECTION SOLUTION", "code_information": [{"code": "J0600", "type": "HCPCS"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 6209.68, "maximum": 40033.81, "gross_charge": 25717.5, "discounted_cash": 15430.5, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18850.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 19108.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 19108.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 19288.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 19108.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 21816.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14041.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13295.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12704.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13784.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 26266.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 40033.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 21859.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 21859.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 14144.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21242.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 6209.68, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 6209.68, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14041.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 16716.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 15301.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 14144.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 6209.68, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18850.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12858.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19416.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16716.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12472.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 6209.68, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19288.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14041.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19288.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20574.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 6209.68, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15687.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20574.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 21816.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 6209.68, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13938.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13938.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 19288.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16716.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18850.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18850.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18850.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 19108.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 14916.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 26266.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 40033.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 21859.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21242.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19288.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19416.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21859.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19416.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16716.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 26266.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 40033.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21242.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 19288.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 6209.68, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 6209.68, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19288.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13938.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14041.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 6209.68, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20574.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 6209.68, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 6209.68, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 19108.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19288.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 6209.68, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 14916.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19288.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET", "code_information": [{"code": "J0602", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.26, "maximum": 5.56, "gross_charge": 6.95, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SEVELAMER CARBONATE 2.4 GRAM ORAL POWDER PACKET", "code_information": [{"code": "J0602", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.27, "maximum": 5.6, "gross_charge": 7.0, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SEVELAMER HCL 800 MG TABLET", "code_information": [{"code": "J0603", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 4.09, "maximum": 17.96, "gross_charge": 22.45, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CALCIUM GLUCONATE 100 MG/ML (10 %) INTRAVENOUS SOLUTION", "code_information": [{"code": "J0612", "type": "HCPCS"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 12.69, "maximum": 193.41, "gross_charge": 47.6, "discounted_cash": 28.56, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 14.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 14.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 12.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 19.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 12.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 19.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 12.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 19.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CALCIUM GLUCONATE 100 MG/ML (10 %) INTRAVENOUS SOLUTION", "code_information": [{"code": "J0612", "type": "HCPCS"}], "drug_information": {"unit": 100, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 12.69, "maximum": 193.41, "gross_charge": 193.6, "discounted_cash": 116.16, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 141.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 143.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 143.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 145.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 145.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 154.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 140.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 145.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 145.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 154.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 143.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 140.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 95.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 126.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 193.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 164.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 164.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 159.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 143.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 134.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 125.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 141.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 96.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 146.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 125.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 145.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 125.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 141.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 141.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 143.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 126.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 193.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 164.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 159.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 141.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 145.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 146.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 164.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 146.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 125.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 126.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 193.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 159.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 145.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 145.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 154.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 143.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 145.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 145.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CALCIUM GLUCONATE 100 MG/ML (10 %) INTRAVENOUS SOLUTION", "code_information": [{"code": "J0612", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 12.69, "maximum": 193.41, "gross_charge": 105.6, "discounted_cash": 63.36, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 70.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 70.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 63.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 96.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 63.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 96.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 63.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 96.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CALCIUM GLUCONATE IV SYRINGE 100 MG/ML (PEDIATRICS)", "code_information": [{"code": "J0612", "type": "HCPCS"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 12.69, "maximum": 193.41, "gross_charge": 47.6, "discounted_cash": 28.56, "payers_information": [{"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 12.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 19.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 12.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 19.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 14.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 12.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 19.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 14.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CALCIUM GLUCONATE IV SYRINGE 100 MG/ML (PEDIATRICS)", "code_information": [{"code": "J0612", "type": "HCPCS"}], "drug_information": {"unit": 100, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 12.69, "maximum": 193.41, "gross_charge": 193.6, "discounted_cash": 116.16, "payers_information": [{"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 145.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 145.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 126.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 193.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 159.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 146.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 125.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 141.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 141.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 143.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 145.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 125.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 164.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 146.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 145.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 141.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 126.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 193.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 164.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 159.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 141.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 143.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 143.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 145.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 145.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 154.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 140.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 145.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 154.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 145.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 146.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 125.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 96.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 141.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 143.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 134.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 125.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 126.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 193.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 164.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 164.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 159.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 95.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 143.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 140.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 145.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 145.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 143.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 154.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CALCIUM GLUCONATE IV SYRINGE 100 MG/ML (PEDIATRICS)", "code_information": [{"code": "J0612", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 12.69, "maximum": 193.41, "gross_charge": 105.6, "discounted_cash": 63.36, "payers_information": [{"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 63.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 96.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 63.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 96.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 70.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 63.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 96.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 70.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CALCIUM GLUCONATE INFUSION 100 MG/ML (PEDIATRICS)", "code_information": [{"code": "J0612", "type": "HCPCS"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 2.4, "maximum": 386.82, "gross_charge": 16.4, "discounted_cash": 9.84, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 14.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 12.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 19.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 14.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 12.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 19.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 12.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 19.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CALCIUM GLUCONATE INFUSION 100 MG/ML (PEDIATRICS)", "code_information": [{"code": "J0612", "type": "HCPCS"}], "drug_information": {"unit": 100, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 2.4, "maximum": 386.82, "gross_charge": 81.6, "discounted_cash": 48.96, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 140.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 126.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 193.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 140.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 126.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 193.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 126.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 193.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CALCIUM GLUCONATE INFUSION 100 MG/ML (PEDIATRICS)", "code_information": [{"code": "J0612", "type": "HCPCS"}], "drug_information": {"unit": 15, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 2.4, "maximum": 386.82, "gross_charge": 24.6, "discounted_cash": 14.76, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 21.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 19.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 29.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 21.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 19.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 29.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 19.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 29.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CALCIUM GLUCONATE INFUSION 100 MG/ML (PEDIATRICS)", "code_information": [{"code": "J0612", "type": "HCPCS"}], "drug_information": {"unit": 150, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 2.4, "maximum": 386.82, "gross_charge": 122.4, "discounted_cash": 73.44, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 210.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 190.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 290.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 97.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 97.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 210.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 190.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 290.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 190.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 290.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 97.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CALCIUM GLUCONATE INFUSION 100 MG/ML (PEDIATRICS)", "code_information": [{"code": "J0612", "type": "HCPCS"}], "drug_information": {"unit": 20, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 2.4, "maximum": 386.82, "gross_charge": 32.8, "discounted_cash": 19.68, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 28.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 25.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 38.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 28.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 25.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 38.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 25.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 38.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CALCIUM GLUCONATE INFUSION 100 MG/ML (PEDIATRICS)", "code_information": [{"code": "J0612", "type": "HCPCS"}], "drug_information": {"unit": 200, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 2.4, "maximum": 386.82, "gross_charge": 149.6, "discounted_cash": 89.76, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 109.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 111.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 111.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 111.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 280.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 253.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 386.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 123.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 110.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 97.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 109.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 97.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 119.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 119.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 280.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 253.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 386.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 123.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 109.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 97.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 109.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 111.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 109.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 97.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 253.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 386.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 123.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 119.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 111.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CALCIUM GLUCONATE INFUSION 100 MG/ML (PEDIATRICS)", "code_information": [{"code": "J0612", "type": "HCPCS"}], "drug_information": {"unit": 25, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 2.4, "maximum": 386.82, "gross_charge": 40.95, "discounted_cash": 24.57, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 35.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 31.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 48.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 35.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 31.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 48.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 31.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 48.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CALCIUM GLUCONATE INFUSION 100 MG/ML (PEDIATRICS)", "code_information": [{"code": "J0612", "type": "HCPCS"}], "drug_information": {"unit": 3, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 2.4, "maximum": 386.82, "gross_charge": 4.95, "discounted_cash": 2.97, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CALCIUM GLUCONATE INFUSION 100 MG/ML (PEDIATRICS)", "code_information": [{"code": "J0612", "type": "HCPCS"}], "drug_information": {"unit": 30, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 2.4, "maximum": 386.82, "gross_charge": 49.15, "discounted_cash": 29.49, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 42.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 38.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 58.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 42.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 38.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 58.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 38.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 58.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CALCIUM GLUCONATE INFUSION 100 MG/ML (PEDIATRICS)", "code_information": [{"code": "J0612", "type": "HCPCS"}], "drug_information": {"unit": 35, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 2.4, "maximum": 386.82, "gross_charge": 57.35, "discounted_cash": 34.41, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 49.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 44.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 67.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 49.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 44.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 67.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 44.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 67.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CALCIUM GLUCONATE INFUSION 100 MG/ML (PEDIATRICS)", "code_information": [{"code": "J0612", "type": "HCPCS"}], "drug_information": {"unit": 40, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 2.4, "maximum": 386.82, "gross_charge": 65.55, "discounted_cash": 39.33, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 56.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 50.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 77.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 56.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 50.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 77.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 50.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 77.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CALCIUM GLUCONATE INFUSION 100 MG/ML (PEDIATRICS)", "code_information": [{"code": "J0612", "type": "HCPCS"}], "drug_information": {"unit": 45, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 2.4, "maximum": 386.82, "gross_charge": 73.75, "discounted_cash": 44.25, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 63.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 57.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 87.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 63.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 57.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 87.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 57.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 87.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CALCIUM GLUCONATE INFUSION 100 MG/ML (PEDIATRICS)", "code_information": [{"code": "J0612", "type": "HCPCS"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 2.4, "maximum": 386.82, "gross_charge": 8.2, "discounted_cash": 4.92, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 9.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 9.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 9.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CALCIUM GLUCONATE INFUSION 100 MG/ML (PEDIATRICS)", "code_information": [{"code": "J0612", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 2.4, "maximum": 386.82, "gross_charge": 81.9, "discounted_cash": 49.14, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 70.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 63.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 96.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 70.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 63.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 96.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 63.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 96.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CALCIUM GLUCONATE 100 MG/ML (10 %) INTRAVENOUS SOLUTION (USE WITH TPN CALCULATOR)", "code_information": [{"code": "J0612", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 51.22, "maximum": 96.71, "gross_charge": 105.6, "discounted_cash": 63.36, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 70.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 63.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 96.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 70.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 63.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 96.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 63.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 96.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE", "code_information": [{"code": "J0615", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.62, "maximum": 2.72, "gross_charge": 3.4, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "METOPROLOL TARTRATE 5 MG/5 ML INTRAVENOUS SOLUTION", "code_information": [{"code": "J0616", "type": "HCPCS"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.7, "maximum": 3.87, "gross_charge": 3.5, "discounted_cash": 2.1, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CALCITONIN (SALMON) 200 UNIT/ML INJECTION SOLUTION", "code_information": [{"code": "J0630", "type": "HCPCS"}], "drug_information": {"unit": 2, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 343.12, "maximum": 5157.6, "gross_charge": 1885.25, "discounted_cash": 1131.15, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1381.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 1400.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1400.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 1413.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1400.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2825.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1029.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 974.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 931.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1010.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3384.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 5157.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1602.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 1602.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1036.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1557.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 388.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 343.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1029.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 1225.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1121.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 1036.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1381.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 942.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1423.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1225.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 914.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1413.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1029.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1413.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1508.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1150.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1508.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2825.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 441.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1021.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1021.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1413.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1225.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1381.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1381.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1381.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1400.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1093.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3384.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 5157.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 1602.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1557.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1413.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1423.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1602.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1423.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1225.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3384.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 5157.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1557.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1413.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 441.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 441.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1413.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1021.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1029.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 441.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1508.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1400.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1413.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1093.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1413.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CANAKINUMAB (PF) 150 MG/ML SUBCUTANEOUS SOLUTION", "code_information": [{"code": "J0638", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 22161.15, "maximum": 142871.97, "gross_charge": 95026.75, "discounted_cash": 57016.05, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 69654.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 70604.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 70604.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 71270.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 70604.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 71487.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51884.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49128.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46943.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50934.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 93741.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 142871.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 80772.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 80772.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 52264.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78492.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 22161.15, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 22161.15, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51884.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 61767.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 56540.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 52264.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 22161.15, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 69654.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47513.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71745.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 61767.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46087.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 22161.15, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71270.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51884.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71270.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 76021.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 22161.15, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 57966.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 76021.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 71487.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 22161.15, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51504.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51504.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 71270.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 61767.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 69654.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 69654.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 69654.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 70604.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 55115.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 93741.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 142871.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 80772.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78492.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71270.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71745.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80772.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71745.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 61767.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 93741.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 142871.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78492.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 71270.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 22161.15, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 22161.15, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71270.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51504.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51884.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 22161.15, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 76021.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 22161.15, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 22161.15, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 70604.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71270.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 22161.15, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 55115.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71270.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LEUCOVORIN CALCIUM 500 MG SOLUTION FOR INJECTION", "code_information": [{"code": "J0640", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 109.78, "maximum": 247.56, "gross_charge": 226.35, "discounted_cash": 135.81, "payers_information": [{"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 170.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 147.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 192.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 169.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 169.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 122.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 123.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 181.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 168.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 169.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 131.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 169.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 165.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 168.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 168.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 169.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 168.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 133.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 123.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 117.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 111.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 162.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 247.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 192.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 192.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 124.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 186.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 147.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 134.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 124.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 121.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 123.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 165.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 113.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 170.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 147.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 109.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 169.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 123.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 169.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 181.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 138.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 181.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 133.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 122.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 122.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 169.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 147.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 165.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 168.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 131.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 162.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 247.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 192.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 186.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 165.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 165.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 169.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 170.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 162.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 247.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 186.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LEUCOVORIN IV SYRINGE 10 MG/ML (PEDIATRICS)", "code_information": [{"code": "J0640", "type": "HCPCS"}], "drug_information": {"unit": 100, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 267.0, "maximum": 1013.29, "gross_charge": 1192.1, "discounted_cash": 715.26, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 885.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 267.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 650.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 616.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 588.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 596.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 873.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 650.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 638.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 774.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 709.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 655.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 324.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 495.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1013.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 1013.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 655.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 984.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 324.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 495.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 984.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 900.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 894.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 873.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 873.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 324.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 495.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 1013.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 984.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 873.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 885.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 691.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 894.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 774.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 646.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 646.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 727.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 953.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 267.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 894.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 953.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 650.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 894.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 900.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 774.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 578.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 873.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 885.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 885.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 894.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 894.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 691.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 894.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 885.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 953.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 650.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 646.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 894.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 894.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1013.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 900.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 774.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LEUCOVORIN CALCIUM 100 MG SOLUTION FOR INJECTION", "code_information": [{"code": "J0640", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 26.7, "maximum": 97.11, "gross_charge": 114.25, "discounted_cash": 68.55, "payers_information": [{"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 97.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 26.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 32.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 49.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 97.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 32.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 49.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 32.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 49.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 97.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 97.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 26.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LEVOTHYROXINE 100 MCG INTRAVENOUS POWDER FOR SOLUTION", "code_information": [{"code": "J0650", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 166.48, "maximum": 269.6, "gross_charge": 337.0, "discounted_cash": 202.2, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 247.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 260.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 166.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 180.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 185.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 185.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 247.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 168.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 269.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 269.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 260.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 182.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 252.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 247.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 247.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 247.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 195.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 252.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 182.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 269.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 195.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LEVOTHYROXINE 20 MCG/ML INTRAVENOUS SOLUTION", "code_information": [{"code": "J0651", "type": "HCPCS"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 69.36, "maximum": 313.28, "gross_charge": 391.6, "discounted_cash": 234.96, "payers_information": [{"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 69.36, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 215.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 69.36, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 287.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 195.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 69.36, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 313.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 69.36, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 313.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 240.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 69.36, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 212.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 293.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 287.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 287.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 287.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 227.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 293.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 69.36, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 69.36, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 212.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 69.36, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 313.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 69.36, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 69.36, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 69.36, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 227.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 287.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 240.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 193.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 209.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 215.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 69.36, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION", "code_information": [{"code": "J0665", "type": "HCPCS"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.0, "maximum": 12.33, "gross_charge": 14.5, "discounted_cash": 8.7, "payers_information": [{"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) INJECTION SOLUTION", "code_information": [{"code": "J0665", "type": "HCPCS"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 4.5, "maximum": 12.41, "gross_charge": 14.6, "discounted_cash": 8.76, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 9.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 9.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 9.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION", "code_information": [{"code": "J0665", "type": "HCPCS"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.5, "maximum": 10.75, "gross_charge": 12.65, "discounted_cash": 7.59, "payers_information": [{"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CARBOPROST TROMETHAMINE 250 MCG/ML INTRAMUSCULAR SOLUTION", "code_information": [{"code": "J0675", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 41.11, "maximum": 562.92, "gross_charge": 703.65, "discounted_cash": 422.19, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 515.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 351.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 347.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 377.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 387.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 41.11, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 41.11, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 387.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 41.11, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 515.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 351.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 41.11, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 562.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 562.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 351.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 41.11, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 41.11, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 381.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 527.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 515.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 515.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 515.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 408.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 527.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 41.11, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 41.11, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 381.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 41.11, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 562.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 41.11, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 41.11, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 41.11, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 408.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CARBOPROST TROMETHAMINE 250 MCG/ML INTRAMUSCULAR SOLUTION|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "J0675", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 27.4, "maximum": 375.28, "gross_charge": 469.1, "discounted_cash": 281.46, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 272.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 27.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 27.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 27.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 375.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 27.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 254.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 27.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 27.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 351.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 343.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 272.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 343.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 343.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 351.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 254.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 27.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 27.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 375.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 234.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 375.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 27.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 234.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 343.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 27.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 258.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 27.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 27.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 258.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 251.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 231.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 234.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 343.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK", "code_information": [{"code": "J0690", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 11.36, "maximum": 66.0, "gross_charge": 77.65, "discounted_cash": 46.59, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 14.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 21.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 14.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 21.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 14.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 21.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION", "code_information": [{"code": "J0690", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.77, "maximum": 10.7, "gross_charge": 3.65, "discounted_cash": 2.19, "payers_information": [{"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 10.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 10.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 10.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CEFAZOLIN 10 GRAM SOLUTION FOR INJECTION", "code_information": [{"code": "J0690", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 12.44, "maximum": 107.02, "gross_charge": 25.65, "discounted_cash": 15.39, "payers_information": [{"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 70.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 107.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 70.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 107.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 56.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 56.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 70.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 107.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CEFAZOLIN 500 MG SOLUTION FOR INJECTION", "code_information": [{"code": "J0690", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 2.84, "maximum": 6.5, "gross_charge": 7.65, "discounted_cash": 4.59, "payers_information": [{"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CEFAZOLIN 1 GRAM INTRAMUSCULAR SOLUTION FOR INJECTION", "code_information": [{"code": "J0690", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.77, "maximum": 10.7, "gross_charge": 3.65, "discounted_cash": 2.19, "payers_information": [{"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 10.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 10.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 10.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CEFAZOLIN 500 MG INTRAMUSCULAR SOLUTION FOR INJECTION", "code_information": [{"code": "J0690", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 2.84, "maximum": 6.5, "gross_charge": 7.65, "discounted_cash": 4.59, "payers_information": [{"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CEFAZOLIN IV SYRINGE 40 MG/ML (PEDIATRICS)", "code_information": [{"code": "J0690", "type": "HCPCS"}], "drug_information": {"unit": 25, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.58, "maximum": 10.7, "gross_charge": 3.25, "discounted_cash": 1.95, "payers_information": [{"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 10.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 10.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 10.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CEFEPIME 2 GRAM SOLUTION FOR INJECTION", "code_information": [{"code": "J0692", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 11.49, "maximum": 22.44, "gross_charge": 23.7, "discounted_cash": 14.22, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 16.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 14.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 22.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 16.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 14.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 22.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 14.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 22.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CEFEPIME IV SYRINGE 40 MG/ML (PEDIATRICS)", "code_information": [{"code": "J0692", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 14.04, "maximum": 24.61, "gross_charge": 28.95, "discounted_cash": 17.37, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 14.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 22.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 14.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 22.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 16.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 14.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 22.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 16.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CEFOXITIN IV SYRINGE 50 MG/ML (PEDIATRICS)", "code_information": [{"code": "J0694", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 24.98, "maximum": 91.68, "gross_charge": 51.5, "discounted_cash": 30.9, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 52.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 60.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 91.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 52.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 60.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 91.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 60.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 91.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CEFOXITIN IV SYRINGE 50 MG/ML (PEDIATRICS)|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "J0694", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 16.66, "maximum": 61.12, "gross_charge": 34.35, "discounted_cash": 20.61, "payers_information": [{"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 40.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 61.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 40.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 61.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 34.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 40.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 61.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 34.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CEFOXITIN 1 GRAM INTRAVENOUS SOLUTION", "code_information": [{"code": "J0694", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 11.4, "maximum": 30.56, "gross_charge": 23.5, "discounted_cash": 14.1, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 17.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 30.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 17.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 30.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 30.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CEFOXITIN 1 GRAM INTRAVENOUS SOLUTION|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "J0694", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 12.93, "maximum": 15.28, "gross_charge": 23.5, "discounted_cash": 14.1, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CEFOXITIN 10 GRAM INTRAVENOUS SOLUTION", "code_information": [{"code": "J0694", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 70.64, "maximum": 305.59, "gross_charge": 145.65, "discounted_cash": 87.39, "payers_information": [{"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 107.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 200.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 305.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 123.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 123.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 173.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 109.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 109.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 116.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 173.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 109.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 109.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 116.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 109.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 109.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 109.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 109.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 200.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 305.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 109.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 123.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 109.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 109.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 200.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 305.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 123.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 116.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 109.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 109.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CEFTOLOZANE-TAZOBACTAM 1.5 GRAM INTRAVENOUS SOLUTION", "code_information": [{"code": "J0695", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 178.94, "maximum": 637.76, "gross_charge": 797.2, "discounted_cash": 478.32, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 617.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 178.94, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 178.94, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 178.94, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 178.94, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 178.94, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 462.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 637.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 617.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 178.94, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 462.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 178.94, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 178.94, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 178.94, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 178.94, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 178.94, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 178.94, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CEFTOLOZANE-TAZOBACTAM IV SYRINGE 9 MG/ML (DOSED AS CEFTOLOZANE) (PEDIATRICS)", "code_information": [{"code": "J0695", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 80.52, "maximum": 277.74, "gross_charge": 205.95, "discounted_cash": 123.57, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 119.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 80.52, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 164.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 277.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 80.52, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 80.52, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 80.52, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 80.52, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 119.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 80.52, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 80.52, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 277.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 80.52, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 80.52, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 80.52, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 80.52, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 80.52, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CEFTOLOZANE-TAZOBACTAM IVPB 9 MG/ML (DOSED AS CEFTOLOZANE) (PEDIATRICS)", "code_information": [{"code": "J0695", "type": "HCPCS"}], "drug_information": {"unit": 100, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 161.05, "maximum": 555.48, "gross_charge": 308.75, "discounted_cash": 185.25, "payers_information": [{"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 161.05, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 161.05, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 161.05, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 161.05, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 555.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 179.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 161.05, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 161.05, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 161.05, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 161.05, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 161.05, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 247.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 555.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 161.05, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 179.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 161.05, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 161.05, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CEFTRIAXONE 1 GRAM INJ (SO)", "code_information": [{"code": "J0696", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.18, "maximum": 11.86, "gross_charge": 6.55, "discounted_cash": 3.93, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 11.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 11.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 11.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CEFTRIAXONE 1 GRAM INJ (SO)|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "J0696", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.6, "maximum": 4.26, "gross_charge": 6.55, "discounted_cash": 3.93, "payers_information": [{"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CEFTRIAXONE 1 GRAM INTRAMUSCULAR INJECTION", "code_information": [{"code": "J0696", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.98, "maximum": 14.83, "gross_charge": 8.2, "discounted_cash": 4.92, "payers_information": [{"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 9.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 14.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 9.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 14.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 9.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 14.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CEFTRIAXONE 1 GRAM INTRAMUSCULAR INJECTION|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "J0696", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.18, "maximum": 11.86, "gross_charge": 6.55, "discounted_cash": 3.93, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 11.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 11.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 11.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CEFTRIAXONE IV SYRINGE 40 MG/ML (PEDIATRICS)", "code_information": [{"code": "J0696", "type": "HCPCS"}], "drug_information": {"unit": 250, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 10.09, "maximum": 118.62, "gross_charge": 96.0, "discounted_cash": 57.6, "payers_information": [{"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 77.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 118.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 64.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 77.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 118.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 77.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 118.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 64.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CEFTRIAXONE IV SYRINGE 40 MG/ML (PEDIATRICS)", "code_information": [{"code": "J0696", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 10.09, "maximum": 118.62, "gross_charge": 20.8, "discounted_cash": 12.48, "payers_information": [{"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 15.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 23.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 12.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 15.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 23.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 15.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 23.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 12.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CEFTRIAXONE IV SYRINGE 40 MG/ML (PEDIATRICS)|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "J0696", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 11.44, "maximum": 62.4, "gross_charge": 20.8, "discounted_cash": 12.48, "payers_information": [{"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CEFTRIAXONE IV SYRINGE 40 MG/ML (PEDIATRICS)|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "J0696", "type": "HCPCS"}], "drug_information": {"unit": 250, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 11.44, "maximum": 62.4, "gross_charge": 96.0, "discounted_cash": 57.6, "payers_information": [{"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CEFTRIAXONE IV SYRINGE 40 MG/ML (NON-STANDARD) (PEDIATRICS)", "code_information": [{"code": "J0696", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 10.09, "maximum": 23.72, "gross_charge": 20.8, "discounted_cash": 12.48, "payers_information": [{"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 15.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 23.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 12.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 12.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 15.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 23.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 15.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 23.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CEFTRIAXONE IV SYRINGE 40 MG/ML (NON-STANDARD) (PEDIATRICS)|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "J0696", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 11.44, "maximum": 13.52, "gross_charge": 20.8, "discounted_cash": 12.48, "payers_information": [{"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CEFTRIAXONE 500 MG SOLUTION FOR INJECTION", "code_information": [{"code": "J0696", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.24, "maximum": 11.39, "gross_charge": 13.4, "discounted_cash": 8.04, "payers_information": [{"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CEFTRIAXONE 500 MG SOLUTION FOR INJECTION|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "J0696", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 7.37, "maximum": 8.71, "gross_charge": 13.4, "discounted_cash": 8.04, "payers_information": [{"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CEFTRIAXONE 10 GRAM SOLUTION FOR INJECTION", "code_information": [{"code": "J0696", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 28.83, "maximum": 118.62, "gross_charge": 59.45, "discounted_cash": 35.67, "payers_information": [{"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 77.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 118.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 64.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 64.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 77.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 118.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 77.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 118.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CEFTRIAXONE 2 GRAM/50 ML IN DEXTROSE (ISO-OSM) INTRAVENOUS PIGGYBACK", "code_information": [{"code": "J0696", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 12.96, "maximum": 117.3, "gross_charge": 138.0, "discounted_cash": 82.8, "payers_information": [{"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 110.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 15.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 23.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 113.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 117.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 15.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 23.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 117.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 113.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 110.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 12.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 12.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 110.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 15.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 23.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 117.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 117.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 113.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 95.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CEFTRIAXONE 2 GRAM/50 ML IN DEXTROSE (ISO-OSM) INTRAVENOUS PIGGYBACK|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "J0696", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 75.9, "maximum": 89.7, "gross_charge": 138.0, "discounted_cash": 82.8, "payers_information": [{"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION", "code_information": [{"code": "J0697", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 11.08, "maximum": 26.43, "gross_charge": 22.85, "discounted_cash": 13.71, "payers_information": [{"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 15.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 17.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 26.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 15.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 17.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 26.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 17.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 26.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "J0697", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 5.55, "maximum": 13.22, "gross_charge": 11.45, "discounted_cash": 6.87, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 13.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 13.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 13.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CEFUROXIME INTRACAMERAL SYRINGE 20 MG/2 ML (PREMIX)", "code_information": [{"code": "J0697", "type": "HCPCS"}], "drug_information": {"unit": 2, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 5.46, "maximum": 13.22, "gross_charge": 11.25, "discounted_cash": 6.75, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 13.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 13.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 13.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CEFIDEROCOL 1 GRAM INTRAVENOUS SOLUTION", "code_information": [{"code": "J0699", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 241.9, "maximum": 851.64, "gross_charge": 1064.55, "discounted_cash": 638.73, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 780.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 811.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 525.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 570.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 585.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 241.9, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 241.9, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 585.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 241.9, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 780.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 532.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 241.9, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 851.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 241.9, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 851.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 811.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 241.9, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 576.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 798.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 780.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 780.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 780.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 617.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 798.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 241.9, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 241.9, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 576.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 241.9, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 851.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 241.9, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 241.9, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 241.9, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 617.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "BETAMETHASONE ACETATE AND SODIUM PHOS 6 MG/ML SUSPENSION FOR INJECTION", "code_information": [{"code": "J0702", "type": "HCPCS"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 101.56, "maximum": 222.74, "gross_charge": 209.4, "discounted_cash": 125.64, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 153.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 155.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 155.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 157.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 155.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 116.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 146.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 222.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 177.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 177.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 115.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 172.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 124.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 115.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 153.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 158.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 157.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 157.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 167.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 167.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 116.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 113.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 113.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 157.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 153.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 153.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 153.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 155.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 121.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 146.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 222.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 177.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 172.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 157.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 158.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 177.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 158.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 146.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 222.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 172.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 157.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 157.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 113.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 167.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 155.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 157.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 121.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 157.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CEFEPIME 2 GRAM/50 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK", "code_information": [{"code": "J0703", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 68.56, "maximum": 114.64, "gross_charge": 143.3, "discounted_cash": 85.98, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 68.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 68.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 107.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 107.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CAFFEINE CITRATE 60 MG/3 ML (20 MG/ML) INTRAVENOUS SOLUTION", "code_information": [{"code": "J0706", "type": "HCPCS"}], "drug_information": {"unit": 3, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 13.0, "maximum": 93.61, "gross_charge": 26.8, "discounted_cash": 16.08, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 82.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 61.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 93.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 82.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 61.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 93.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 61.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 93.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CEFTAROLINE FOSAMIL 600 MG INTRAVENOUS SOLUTION", "code_information": [{"code": "J0712", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 254.34, "maximum": 859.8, "gross_charge": 929.95, "discounted_cash": 557.97, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 681.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 859.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 459.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 498.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 254.34, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 254.34, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 511.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 511.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 254.34, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 681.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 464.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 254.34, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 743.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 254.34, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 743.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 859.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 254.34, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 504.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 697.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 681.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 681.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 539.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 681.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 697.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 254.34, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 254.34, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 504.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 254.34, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 539.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 743.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 254.34, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 254.34, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 254.34, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CEFTAROLINE IV SYRINGE 12 MG/ML (PEDIATRICS)", "code_information": [{"code": "J0712", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 254.34, "maximum": 859.8, "gross_charge": 930.0, "discounted_cash": 558.0, "payers_information": [{"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 254.34, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 254.34, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 254.34, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 744.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 539.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 498.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 459.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 859.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 681.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 254.34, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 465.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 681.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 254.34, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 511.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 511.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 254.34, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 254.34, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 254.34, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 504.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 254.34, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 254.34, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 697.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 681.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 681.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 539.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 681.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 697.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 504.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 254.34, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 744.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 859.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 254.34, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 744.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CEFTAZIDIME IV SYRINGE 50 MG/ML (PEDIATRICS)", "code_information": [{"code": "J0713", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 26.97, "maximum": 47.39, "gross_charge": 55.6, "discounted_cash": 33.36, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 27.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 31.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 47.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 27.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 31.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 47.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 31.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 47.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CEFTAZIDIME 1 GRAM SOLUTION FOR INJECTION (SO)", "code_information": [{"code": "J0713", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 8.66, "maximum": 18.95, "gross_charge": 17.85, "discounted_cash": 10.71, "payers_information": [{"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 12.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 18.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 12.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 18.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 12.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 18.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CEFTAZIDIME 1 GRAM SOLUTION FOR INTRAMUSCULAR INJ (SO)", "code_information": [{"code": "J0713", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 12.97, "maximum": 28.43, "gross_charge": 26.75, "discounted_cash": 16.05, "payers_information": [{"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 18.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 28.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 16.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 18.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 28.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 18.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 28.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 16.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CEFTAZIDIME 1 GRAM SOLUTION FOR INTRAMUSCULAR INJ (SO)|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "J0713", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 8.66, "maximum": 18.95, "gross_charge": 17.85, "discounted_cash": 10.71, "payers_information": [{"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 12.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 18.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 12.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 18.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 12.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 18.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CEFTAZIDIME 6 GRAM SOLUTION FOR INJECTION", "code_information": [{"code": "J0713", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 43.7, "maximum": 113.73, "gross_charge": 90.1, "discounted_cash": 54.06, "payers_information": [{"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 66.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 74.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 113.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 74.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 113.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 66.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 74.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 113.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CEFTAZIDIME-AVIBACTAM 2.5 GRAM INTRAVENOUS SOLUTION", "code_information": [{"code": "J0714", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 418.84, "maximum": 2700.26, "gross_charge": 1623.7, "discounted_cash": 974.22, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1190.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 1206.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1206.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 1217.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1206.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1418.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 886.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 839.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 802.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 870.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1771.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 2700.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1380.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 1380.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 893.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1341.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 418.84, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 418.84, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 1055.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 966.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 893.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 886.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 418.84, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1190.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 811.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1225.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1055.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 787.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 418.84, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1217.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1217.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1298.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 886.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 418.84, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 990.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1298.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1418.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 880.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 880.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1217.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1055.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 418.84, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1190.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1771.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 2700.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 1380.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1341.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1190.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1206.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 941.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1190.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1217.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1225.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1380.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1225.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1055.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1771.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 2700.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1341.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1217.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 418.84, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 418.84, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1217.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 880.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 886.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 418.84, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1298.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 418.84, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 418.84, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1206.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1217.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 418.84, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 941.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1217.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CEFTAZIDIME-AVIBACTAM IV SYRINGE 40 MG/ML (PEDIATRIC)", "code_information": [{"code": "J0714", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 418.84, "maximum": 2700.26, "gross_charge": 2345.2, "discounted_cash": 1407.12, "payers_information": [{"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1758.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1360.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 418.84, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1758.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1742.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 418.84, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 418.84, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1876.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 418.84, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1280.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1271.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1758.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 418.84, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 418.84, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1758.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1771.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 2700.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1937.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1770.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1524.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1993.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1770.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1758.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1719.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1719.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1742.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1360.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1771.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 2700.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 1993.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1937.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1719.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 418.84, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1758.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1524.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1271.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1271.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1430.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1876.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1418.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 418.84, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1280.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1758.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1876.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1758.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 418.84, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1770.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1524.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1137.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1172.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1719.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 418.84, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1280.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 1524.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1395.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 1289.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 418.84, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 418.84, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1771.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 2700.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1993.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 1993.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1289.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1937.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1257.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1280.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1212.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1158.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1742.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1418.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1719.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 1742.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1742.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 1758.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CHORIONIC GONADOTROPIN, HUMAN 10,000 UNIT IM POWDER FOR SOLUTION", "code_information": [{"code": "J0725", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 591.8, "maximum": 883.48, "gross_charge": 1104.35, "discounted_cash": 662.61, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 591.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 883.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 591.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 640.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 640.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CLONIDINE (PF) 1,000 MCG/10 ML (100 MCG/ML) EPIDURAL SOLUTION", "code_information": [{"code": "J0735", "type": "HCPCS"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 31.94, "maximum": 111.08, "gross_charge": 65.85, "discounted_cash": 39.51, "payers_information": [{"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 72.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 111.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 72.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 111.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 59.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 72.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 111.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 59.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CLONIDINE (PF) 100 MCG/ML SYRINGE (PEDIATRICS)", "code_information": [{"code": "J0735", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.47, "maximum": 111.08, "gross_charge": 7.15, "discounted_cash": 4.29, "payers_information": [{"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 72.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 111.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 72.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 111.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 72.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 111.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 59.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 59.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CLINDAMYCIN 150 MG/ML INTRAVENOUS SOLUTION/SYRINGE (SO)", "code_information": [{"code": "J0736", "type": "HCPCS"}], "drug_information": {"unit": 2, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 5.29, "maximum": 369.41, "gross_charge": 10.9, "discounted_cash": 6.54, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 12.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 12.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 12.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CLINDAMYCIN 150 MG/ML INTRAVENOUS SOLUTION/SYRINGE (SO)", "code_information": [{"code": "J0736", "type": "HCPCS"}], "drug_information": {"unit": 60, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 5.29, "maximum": 369.41, "gross_charge": 70.6, "discounted_cash": 42.36, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 169.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 242.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 369.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 169.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 242.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 369.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 242.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 369.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK", "code_information": [{"code": "J0737", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 17.43, "maximum": 45.45, "gross_charge": 37.85, "discounted_cash": 22.71, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 17.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 29.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 45.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 29.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 45.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 17.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 29.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 45.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CLINDAMYCIN IV SYRINGE 18 MG/ML (PEDIATRICS)", "code_information": [{"code": "J0737", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 17.43, "maximum": 45.45, "gross_charge": 39.35, "discounted_cash": 23.61, "payers_information": [{"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 17.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 29.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 45.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 29.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 45.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 17.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 29.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 45.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CIDOFOVIR 75 MG/ML INTRAVENOUS SOLUTION", "code_information": [{"code": "J0740", "type": "HCPCS"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 524.48, "maximum": 3381.32, "gross_charge": 2823.25, "discounted_cash": 1693.95, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2069.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 2097.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2097.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 2117.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2097.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1789.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1541.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1459.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1394.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1513.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2218.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 3381.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 2399.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 2399.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1552.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2332.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 524.48, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 524.48, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1541.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 2089.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1962.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 1835.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 524.48, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2069.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1411.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2131.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1835.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1369.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 524.48, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2117.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1541.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2117.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2258.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 524.48, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2117.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2258.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1789.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 524.48, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1530.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1530.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2117.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1835.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2069.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2069.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2069.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2097.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1637.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2218.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 3381.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 2399.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2332.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2117.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2131.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2399.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2131.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1835.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2218.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 3381.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2332.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2117.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 524.48, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 524.48, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2117.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1530.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1541.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 524.48, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2258.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 524.48, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 524.48, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2097.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2117.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 524.48, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1637.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2117.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "IMIPENEM-CILASTATIN 500 MG INTRAVENOUS SOLUTION", "code_information": [{"code": "J0743", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 30.8, "maximum": 91.55, "gross_charge": 63.5, "discounted_cash": 38.1, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 47.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 60.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 91.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 47.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 60.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 91.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 60.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 91.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK", "code_information": [{"code": "J0744", "type": "HCPCS"}], "drug_information": {"unit": 200, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 7.88, "maximum": 25.79, "gross_charge": 16.25, "discounted_cash": 9.75, "payers_information": [{"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 15.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 16.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 25.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 15.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 16.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 25.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 16.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 25.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "J0744", "type": "HCPCS"}], "drug_information": {"unit": 200, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 8.94, "maximum": 10.56, "gross_charge": 16.25, "discounted_cash": 9.75, "payers_information": [{"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CIPROFLOXACIN IV SYRINGE 2 MG/ML (PEDIATRICS)", "code_information": [{"code": "J0744", "type": "HCPCS"}], "drug_information": {"unit": 400, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 13.87, "maximum": 51.58, "gross_charge": 28.6, "discounted_cash": 17.16, "payers_information": [{"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 33.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 51.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 31.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 33.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 51.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 31.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 33.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 51.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CIPROFLOXACIN IV SYRINGE 2 MG/ML (PEDIATRICS)|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "J0744", "type": "HCPCS"}], "drug_information": {"unit": 400, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 15.73, "maximum": 18.59, "gross_charge": 28.6, "discounted_cash": 17.16, "payers_information": [{"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CIPROFLOXACIN IVPB 2 MG/ML (PEDIATRICS)", "code_information": [{"code": "J0744", "type": "HCPCS"}], "drug_information": {"unit": 100, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 4.73, "maximum": 12.89, "gross_charge": 9.75, "discounted_cash": 5.85, "payers_information": [{"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 12.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 12.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 12.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "EMTRICITABINE 200 MG-TENOFOVIR DISOPROXIL FUMARATE 300 MG TABLET", "code_information": [{"code": "J0750", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.34, "maximum": 6.08, "gross_charge": 7.15, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.34, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.34, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.34, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.34, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.34, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.34, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.34, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.34, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.34, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.34, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.34, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.34, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "EMTRICITABINE 200 MG-TENOFOVIR DISOPROXIL FUMARATE 300 MG TABLET FOR CRUSH-DISSOLVE PARTIAL TABLET DOSES", "code_information": [{"code": "J0750", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.34, "maximum": 6.08, "gross_charge": 7.15, "payers_information": [{"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.34, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.34, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.34, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.34, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.34, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.34, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.34, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.34, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.34, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.34, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.34, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.34, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CLEVIDIPINE 50 MG/100 ML INTRAVENOUS EMULSION", "code_information": [{"code": "J0759", "type": "HCPCS"}], "drug_information": {"unit": 100, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 143.2, "maximum": 1137.9, "gross_charge": 750.05, "discounted_cash": 450.03, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 549.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 557.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 557.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 562.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 557.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 375.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 409.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 387.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 370.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 402.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 746.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1137.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 637.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 637.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 412.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 619.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 143.2, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 143.2, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 409.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 487.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 412.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 412.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 143.2, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 549.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 375.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 566.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 487.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 363.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 143.2, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 562.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 409.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 562.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 600.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 143.2, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 600.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 375.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 143.2, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 406.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 406.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 562.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 487.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 549.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 549.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 549.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 557.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 435.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 746.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1137.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 637.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 619.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 562.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 566.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 637.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 566.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 487.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 746.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1137.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 619.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 562.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 143.2, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 143.2, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 562.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 406.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 409.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 143.2, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 600.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 143.2, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 143.2, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 557.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 562.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 143.2, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 435.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 562.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "COLISTIMETHATE IV SYRINGE 75 MG/ML (PEDIATRICS)", "code_information": [{"code": "J0770", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 962.5, "maximum": 2510.18, "gross_charge": 2953.15, "discounted_cash": 1771.89, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2164.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 2194.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2194.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 2214.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2194.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 962.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1612.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1526.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1458.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1277.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1946.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 2510.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 2510.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1624.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2439.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 2185.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 2052.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 1919.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1582.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1612.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2164.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1476.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2229.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1919.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1432.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2214.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1612.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2214.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2362.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2214.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2362.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 962.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1600.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1600.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2214.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1919.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2164.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2194.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1712.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1277.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1946.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 2510.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2439.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2164.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2164.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2214.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2229.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1277.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1946.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2439.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2229.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1919.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2510.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2214.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2214.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1600.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1612.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2362.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2194.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2214.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1712.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2214.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "COLISTIMETHATE SODIUM 150 MG SOLUTION FOR NEBULIZATION", "code_information": [{"code": "J0770", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 29.22, "maximum": 77.88, "gross_charge": 60.25, "discounted_cash": 36.15, "payers_information": [{"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 51.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 77.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 51.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 77.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 51.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 77.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "COLISTIMETHATE SODIUM 150 MG SOLUTION FOR INJECTION", "code_information": [{"code": "J0770", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 29.22, "maximum": 77.88, "gross_charge": 60.25, "discounted_cash": 36.15, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 51.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 77.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 51.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 77.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 51.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 77.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION (PEDIATRICS)", "code_information": [{"code": "J0780", "type": "HCPCS"}], "drug_information": {"unit": 2, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 6.55, "maximum": 16.25, "gross_charge": 13.5, "discounted_cash": 8.1, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 10.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 16.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 10.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 16.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 10.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 16.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION", "code_information": [{"code": "J0780", "type": "HCPCS"}], "drug_information": {"unit": 2, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 6.55, "maximum": 16.25, "gross_charge": 13.5, "discounted_cash": 8.1, "payers_information": [{"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 10.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 16.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 10.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 16.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 10.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 16.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CRIZANLIZUMAB-TMCA 10 MG/ML INTRAVENOUS SOLUTION", "code_information": [{"code": "J0791", "type": "HCPCS"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 2591.86, "maximum": 16709.33, "gross_charge": 10900.3, "discounted_cash": 6540.18, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7989.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 8098.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 8098.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 8175.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 8098.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8759.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5951.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5635.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5384.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5842.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 10963.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 16709.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 9265.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 9265.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5995.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9003.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2591.86, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2591.86, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5951.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 7085.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 6485.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 5995.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2591.86, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7989.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3237.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8229.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7085.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2591.86, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8175.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5951.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8175.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8720.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2591.86, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6649.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8720.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8759.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2591.86, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5907.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5907.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 8175.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7085.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7989.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7989.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7989.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 8098.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6322.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 10963.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 16709.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 9265.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9003.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8175.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8229.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9265.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8229.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7085.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 10963.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 16709.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9003.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 8175.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2591.86, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2591.86, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8175.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5907.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5951.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2591.86, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8720.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2591.86, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2591.86, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 8098.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8175.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2591.86, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6322.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8175.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CORTICOTROPIN 80 UNIT/ML INJECTION GEL", "code_information": [{"code": "J0801", "type": "HCPCS"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 41725.3, "maximum": 141535.1, "gross_charge": 165291.0, "discounted_cash": 99174.6, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 121158.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 141535.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 81653.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 88595.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 90910.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 41725.3, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 41725.3, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 90910.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 41725.3, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 121158.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82645.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 41725.3, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 132232.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 41725.3, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 132232.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 141535.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 41725.3, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 89587.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 123968.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 121158.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 121158.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 121158.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 95868.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 123968.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 41725.3, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 41725.3, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 89587.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 41725.3, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 132232.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 41725.3, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 41725.3, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 41725.3, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 95868.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "COSYNTROPIN 1 MCG/0.2 ML (5 MCG/ML) INJECTION SYRINGE", "code_information": [{"code": "J0834", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "minimum": 1.04, "maximum": 133.13, "gross_charge": 2.15, "discounted_cash": 1.29, "payers_information": [{"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 87.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 133.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 94.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 87.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 133.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 94.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 87.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 133.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "COSYNTROPIN INJECTION SYRINGE 5 MCG/ML (PEDIATRICS)", "code_information": [{"code": "J0834", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 5.12, "maximum": 133.13, "gross_charge": 10.55, "discounted_cash": 6.33, "payers_information": [{"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 87.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 133.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 94.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 87.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 133.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 94.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 87.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 133.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "COSYNTROPIN 0.25 MG SOLUTION FOR INJECTION (125 MCG/ML)(PEDIATRICS)", "code_information": [{"code": "J0834", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 53.23, "maximum": 133.13, "gross_charge": 109.75, "discounted_cash": 65.85, "payers_information": [{"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 87.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 133.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 94.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 87.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 133.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 94.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 87.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 133.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "COSYNTROPIN 0.25 MG SOLUTION FOR INJECTION", "code_information": [{"code": "J0834", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 53.23, "maximum": 133.13, "gross_charge": 109.75, "discounted_cash": 65.85, "payers_information": [{"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 94.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 87.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 133.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 87.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 133.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 94.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 87.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 133.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CROTALIDAE POLYVAL IMMUNE FAB SOLUTION FOR INJECTION", "code_information": [{"code": "J0840", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1826.52, "maximum": 11775.57, "gross_charge": 5263.65, "discounted_cash": 3158.19, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3858.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 3910.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3910.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 3947.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3910.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6290.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2873.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2721.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2600.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2821.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7726.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 11775.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4474.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4474.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2895.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4347.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1826.52, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1826.52, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2873.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 3895.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 3658.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 3421.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1826.52, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3858.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2631.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3974.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3421.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2552.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1826.52, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3947.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2873.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3947.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4210.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1826.52, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3947.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4210.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6290.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1826.52, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2852.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2852.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3947.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3421.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3858.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3858.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3858.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3910.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3052.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7726.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 11775.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4474.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4347.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3947.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3974.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4474.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3974.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3421.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7726.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 11775.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4347.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3947.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1826.52, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1826.52, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3947.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2852.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2873.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1826.52, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4210.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1826.52, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1826.52, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3910.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3947.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1826.52, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3052.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3947.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CROTALIDAE IMMUNE F(AB)2 EQUINE SOLUTION FOR INJECTION", "code_information": [{"code": "J0841", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 2578.9, "maximum": 4925.16, "gross_charge": 5220.45, "discounted_cash": 3132.27, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3826.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3529.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2578.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2798.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2871.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 4925.16, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 4925.16, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 2871.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 4925.16, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3826.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2610.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 4925.16, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4176.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 4925.16, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4176.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3529.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 4925.16, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2829.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3915.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3826.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3826.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3826.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3027.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3915.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 4925.16, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 4925.16, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2829.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 4925.16, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4176.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 4925.16, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 4925.16, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 4925.16, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3027.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CYTOMEGALOVIRUS IMMUNE GLOBULIN 50 MG/ML INTRAVENOUS SOLUTION", "code_information": [{"code": "J0850", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 1808.33, "maximum": 11658.3, "gross_charge": 7747.65, "discounted_cash": 4648.59, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5679.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 5756.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5756.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 5810.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5756.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6115.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4230.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4005.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3827.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4152.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7649.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 11658.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 6585.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 6585.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4261.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6399.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1808.33, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1808.33, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4230.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 5733.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 5384.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 5035.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1808.33, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5679.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2319.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5849.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5035.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3757.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1808.33, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5810.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4230.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5810.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6198.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1808.33, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5810.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6198.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6115.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1808.33, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4199.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4199.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 5810.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5035.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5679.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5679.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5679.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5756.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4493.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7649.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 11658.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 6585.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6399.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5810.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5849.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6585.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5849.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5035.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7649.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 11658.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6399.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 5810.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1808.33, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1808.33, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5810.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4199.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4230.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1808.33, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6198.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1808.33, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1808.33, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5756.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5810.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1808.33, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4493.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5810.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DAPTOMYCIN 350 MG INTRAVENOUS SOLUTION", "code_information": [{"code": "J0878", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 25.83, "maximum": 67.69, "gross_charge": 53.25, "discounted_cash": 31.95, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 35.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 44.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 67.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 35.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 44.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 67.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 44.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 67.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DAPTOMYCIN 350 MG INTRAVENOUS SOLUTION|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "J0878", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 32.48, "maximum": 32.48, "gross_charge": 53.25, "discounted_cash": 31.95, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DAPTOMYCIN IV SYRINGE 20 MG/ML (PEDIATRICS)", "code_information": [{"code": "J0878", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 68.09, "maximum": 193.41, "gross_charge": 140.4, "discounted_cash": 84.24, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 126.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 193.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 119.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 119.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 115.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 100.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 100.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 126.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 193.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 119.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 115.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 119.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 126.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 193.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 115.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DAPTOMYCIN IV SYRINGE 20 MG/ML (PEDIATRICS)|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "J0878", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 85.64, "maximum": 85.64, "gross_charge": 140.4, "discounted_cash": 84.24, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DARBEPOETIN ALFA 40 MCG/ML IN POLYSORBATE INJECTION (PEDIATRICS)", "code_information": [{"code": "J0881", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 120.84, "maximum": 778.8, "gross_charge": 723.8, "discounted_cash": 434.28, "payers_information": [{"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 542.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 120.84, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 419.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 542.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 546.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 470.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 510.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 778.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 597.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 615.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 542.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 120.84, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 120.84, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 542.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 392.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 395.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 120.84, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 579.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 120.84, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 120.84, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 537.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 530.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 537.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 537.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 542.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 537.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 405.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 395.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 374.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 357.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 510.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 778.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 615.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 615.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 398.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 597.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 120.84, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 120.84, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 387.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 395.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 470.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 398.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 398.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 120.84, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 530.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 546.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 470.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 351.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 408.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 120.84, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 542.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 395.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 542.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 579.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 579.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 405.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 120.84, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 120.84, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 392.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 392.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 542.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 470.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 530.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 530.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 510.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 778.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 615.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 597.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 530.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 537.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 419.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 542.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 546.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DARBEPOETIN ALFA 40 MCG/ML IN POLYSORBATE INJECTION (PEDIATRICS)|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "J0881", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 470.47, "maximum": 542.85, "gross_charge": 723.8, "discounted_cash": 434.28, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 542.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 535.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 503.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 470.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DARBEPOETIN ALFA 100 MCG/ML IN POLYSORBATE INJECTION (PEDIATRICS)", "code_information": [{"code": "J0881", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 302.1, "maximum": 1946.99, "gross_charge": 1618.95, "discounted_cash": 971.37, "payers_information": [{"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 1052.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 890.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 890.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1222.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1052.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 785.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1186.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 302.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1295.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1014.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1214.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1295.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 883.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1214.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 302.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1021.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1222.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1214.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1186.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1202.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 938.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1277.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1946.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 1376.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1337.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1186.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1186.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1214.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1052.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 877.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 877.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 302.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 302.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 883.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 867.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 302.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 302.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1277.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1946.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1376.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 1376.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 890.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1337.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 883.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 837.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 799.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1202.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1014.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1186.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 1202.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1202.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 1214.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1202.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 302.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 302.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1295.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 302.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 883.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 877.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1214.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 302.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 302.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1214.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1376.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1277.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1946.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1337.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1222.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1052.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1214.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 938.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 302.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1214.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DARBEPOETIN ALFA 100 MCG/ML IN POLYSORBATE INJECTION (PEDIATRICS)|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "J0881", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 1052.32, "maximum": 1214.21, "gross_charge": 1618.95, "discounted_cash": 971.37, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1214.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 1198.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1125.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 1052.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DARBEPOETIN ALFA 25 MCG/ML IN POLYSORBATE INJECTION", "code_information": [{"code": "J0881", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 75.53, "maximum": 486.75, "gross_charge": 500.0, "discounted_cash": 300.0, "payers_information": [{"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 375.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 75.53, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 290.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 375.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 377.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 325.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 319.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 486.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 413.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 425.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 375.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 75.53, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 75.53, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 375.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 271.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 273.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 75.53, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 75.53, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 75.53, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 371.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 325.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 275.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 275.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 75.53, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 366.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 377.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 325.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 242.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 253.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 375.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 255.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 75.53, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 375.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 273.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 75.53, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 75.53, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 271.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 271.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 375.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 325.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 366.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 366.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 319.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 486.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 425.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 413.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 366.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 371.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 290.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 375.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 377.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 366.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 371.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 371.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 375.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 371.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 253.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 273.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 258.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 247.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 319.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 486.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 425.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 425.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 275.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 413.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 75.53, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 75.53, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 268.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 273.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DARBEPOETIN ALFA 25 MCG/ML IN POLYSORBATE INJECTION|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "J0881", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 325.0, "maximum": 375.0, "gross_charge": 500.0, "discounted_cash": 300.0, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 375.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 370.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 347.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 325.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DARBEPOETIN ALFA 40 MCG/ML IN POLYSORBATE INJECTION", "code_information": [{"code": "J0881", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 120.84, "maximum": 778.8, "gross_charge": 723.8, "discounted_cash": 434.28, "payers_information": [{"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 470.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 398.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 398.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 546.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 470.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 351.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 530.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 120.84, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 579.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 405.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 542.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 579.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 395.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 542.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 120.84, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 408.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 546.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 542.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 530.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 537.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 419.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 510.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 778.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 615.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 597.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 530.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 530.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 542.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 470.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 392.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 392.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 120.84, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 120.84, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 395.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 387.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 120.84, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 120.84, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 510.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 778.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 615.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 615.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 398.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 597.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 395.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 374.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 357.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 537.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 405.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 530.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 537.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 537.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 542.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 537.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 120.84, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 120.84, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 579.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 120.84, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 395.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 392.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 542.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 120.84, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 120.84, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 542.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 615.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 510.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 778.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 597.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 546.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 470.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 542.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 419.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 120.84, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 542.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DARBEPOETIN ALFA 40 MCG/ML IN POLYSORBATE INJECTION|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "J0881", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 470.47, "maximum": 542.85, "gross_charge": 723.8, "discounted_cash": 434.28, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 542.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 535.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 503.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 470.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DARBEPOETIN ALFA 100 MCG/ML IN POLYSORBATE INJECTION", "code_information": [{"code": "J0881", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 302.1, "maximum": 1946.99, "gross_charge": 1618.95, "discounted_cash": 971.37, "payers_information": [{"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 1052.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 890.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 890.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 302.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1186.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1222.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1052.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 785.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1295.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1014.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1214.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1295.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1021.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 302.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1214.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 883.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 302.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 302.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 877.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 877.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1214.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1052.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1186.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1186.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1277.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1946.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 1376.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1337.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1186.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1202.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 938.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1214.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1222.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1186.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 1202.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1202.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 1214.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1202.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1014.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 883.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 837.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 799.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1277.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1946.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1376.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 1376.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 890.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1337.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 302.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 302.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 867.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 883.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1214.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 302.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 938.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1214.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1222.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1052.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1277.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1946.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1337.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1376.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1214.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 302.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 302.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1214.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 877.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 883.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 302.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1295.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 302.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 302.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1202.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DARBEPOETIN ALFA 100 MCG/ML IN POLYSORBATE INJECTION|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "J0881", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 1052.32, "maximum": 1214.21, "gross_charge": 1618.95, "discounted_cash": 971.37, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1214.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 1198.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1125.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 1052.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DECITABINE 50 MG INTRAVENOUS SOLUTION", "code_information": [{"code": "J0894", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 89.29, "maximum": 495.0, "gross_charge": 184.1, "discounted_cash": 110.46, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 134.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 138.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 268.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 95.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 137.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 209.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 156.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 156.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 152.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 119.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 109.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 134.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 495.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 139.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 119.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 138.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 138.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 147.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 147.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 268.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 138.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 119.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 134.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 134.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 134.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 137.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 209.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 156.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 152.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 138.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 139.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 156.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 139.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 119.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 137.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 209.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 152.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 138.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 138.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 147.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 138.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 138.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DEFEROXAMINE SUBCUTANEOUS INFUSION (PEDIATRIC)", "code_information": [{"code": "J0895", "type": "HCPCS"}], "drug_information": {"unit": 20, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 176.54, "maximum": 1365.15, "gross_charge": 364.0, "discounted_cash": 218.4, "payers_information": [{"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 195.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 270.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 304.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 269.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 252.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 236.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 358.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 546.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 309.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 309.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 200.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 300.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 274.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 236.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 176.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 198.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 266.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 182.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 273.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 273.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 291.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 304.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 273.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 291.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 197.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 197.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 266.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 270.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 270.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 273.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 198.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 188.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 179.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 197.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 198.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 291.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 270.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 358.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 546.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 300.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 274.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 236.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 273.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 273.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 273.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 236.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 198.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 266.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 266.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 270.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 211.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 358.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 546.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 309.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 300.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 266.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 273.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 274.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 309.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 273.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 211.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 273.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DEFEROXAMINE SUBCUTANEOUS INFUSION (PEDIATRIC)", "code_information": [{"code": "J0895", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 176.54, "maximum": 1365.15, "gross_charge": 910.0, "discounted_cash": 546.0, "payers_information": [{"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 487.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 676.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 762.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 673.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 632.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 591.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 895.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1365.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 773.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 773.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 500.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 751.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 687.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 591.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 441.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 496.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 667.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 455.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 682.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 682.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 728.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 762.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 682.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 728.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 493.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 493.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 667.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 676.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 676.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 682.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 496.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 470.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 449.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 493.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 496.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 728.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 676.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 895.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1365.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 751.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 687.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 591.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 682.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 682.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 682.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 591.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 496.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 667.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 667.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 676.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 527.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 895.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1365.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 773.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 751.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 667.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 682.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 687.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 773.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 682.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 527.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 682.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DEFEROXAMINE 2 GRAM SOLUTION FOR INJECTION", "code_information": [{"code": "J0895", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 65.43, "maximum": 218.42, "gross_charge": 134.9, "discounted_cash": 80.94, "payers_information": [{"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 107.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 107.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 121.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 143.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 218.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 111.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 121.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 107.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 143.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 218.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 111.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 143.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 218.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 111.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION FOR INJECTION", "code_information": [{"code": "J1010", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 17.53, "maximum": 61.89, "gross_charge": 36.15, "discounted_cash": 21.69, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 32.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 40.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 61.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 32.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 40.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 61.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 40.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 61.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MEDROXYPROGESTERONE 150 MG/ML INTRAMUSCULAR SUSPENSION (SO)", "code_information": [{"code": "J1050", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 6.35, "maximum": 274.5, "gross_charge": 142.9, "discounted_cash": 85.74, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 107.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 274.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 9.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 121.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 121.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 118.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 107.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 107.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 107.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 107.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 274.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 107.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 9.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 121.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 118.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 107.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 107.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 121.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 107.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 9.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 118.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 107.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 107.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 107.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 107.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION", "code_information": [{"code": "J1100", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.38, "maximum": 2.84, "gross_charge": 2.85, "discounted_cash": 1.71, "payers_information": [{"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DEXAMETHASONE IV SYRINGE 0.1 MG/ML (PEDIATRICS)", "code_information": [{"code": "J1100", "type": "HCPCS"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.41, "maximum": 0.77, "gross_charge": 0.9, "discounted_cash": 0.54, "payers_information": [{"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION (PEDIATRICS)", "code_information": [{"code": "J1100", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.38, "maximum": 2.84, "gross_charge": 2.85, "discounted_cash": 1.71, "payers_information": [{"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DIHYDROERGOTAMINE 1 MG/ML INJECTION SOLUTION", "code_information": [{"code": "J1110", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 94.31, "maximum": 367.99, "gross_charge": 194.45, "discounted_cash": 116.67, "payers_information": [{"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 146.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 126.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 241.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 367.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 160.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 145.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 145.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 155.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 144.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 145.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 145.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 142.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 144.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 144.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 145.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 144.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 328.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 96.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 241.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 367.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 165.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 165.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 160.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 143.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 135.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 126.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 142.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 97.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 146.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 126.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 145.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 145.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 155.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 145.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 155.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 328.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 145.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 126.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 142.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 142.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 142.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 144.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 241.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 367.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 165.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 160.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 145.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 146.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 165.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ACETAZOLAMIDE 500 MG SOLUTION FOR INJECTION", "code_information": [{"code": "J1120", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 58.24, "maximum": 164.98, "gross_charge": 137.2, "discounted_cash": 82.32, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 58.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 108.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 164.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 116.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 116.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 113.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 95.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 109.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 109.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 58.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 108.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 164.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 116.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 113.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 108.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 164.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 113.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 116.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 109.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ACETAZOLAMIDE IV SYRINGE 50 MG/ML (PEDIATRICS)", "code_information": [{"code": "J1120", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 291.2, "maximum": 824.89, "gross_charge": 668.75, "discounted_cash": 401.25, "payers_information": [{"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 334.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 490.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 494.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 464.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 434.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 365.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 358.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 365.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 345.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 330.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 541.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 824.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 568.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 568.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 367.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 552.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 496.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 291.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 490.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 496.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 496.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 501.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 501.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 387.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 501.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 496.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 535.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 365.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 362.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 501.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 501.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 568.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 541.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 824.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 552.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 504.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 434.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 504.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 501.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 541.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 824.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 568.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 552.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 490.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 496.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 387.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 490.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 490.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 501.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 434.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 362.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 362.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 501.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 535.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 291.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 501.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 535.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 365.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 501.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 504.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 434.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DIGOXIN 250 MCG/ML INJECTION SOLUTION (SO)", "code_information": [{"code": "J1160", "type": "HCPCS"}], "drug_information": {"unit": 2, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 8.71, "maximum": 61.7, "gross_charge": 17.95, "discounted_cash": 10.77, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 13.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 40.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 61.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 13.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 40.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 61.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 40.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 61.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DIGOXIN IMMUNE FAB 40 MG INTRAVENOUS SOLUTION", "code_information": [{"code": "J1162", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 5166.99, "maximum": 16793.8, "gross_charge": 20467.05, "discounted_cash": 12280.23, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15002.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 16793.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10110.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10970.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 11256.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5166.99, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5166.99, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 11256.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5166.99, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15002.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10233.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5166.99, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16373.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5166.99, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16373.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 16793.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5166.99, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11093.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 15350.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15002.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15002.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15002.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 11870.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 15350.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5166.99, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5166.99, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11093.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5166.99, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16373.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5166.99, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5166.99, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5166.99, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 11870.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION (PEDIATRICS)", "code_information": [{"code": "J1163", "type": "HCPCS"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 5.94, "maximum": 10.41, "gross_charge": 12.25, "discounted_cash": 7.35, "payers_information": [{"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 9.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 9.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 9.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION", "code_information": [{"code": "J1163", "type": "HCPCS"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 5.94, "maximum": 10.41, "gross_charge": 12.25, "discounted_cash": 7.35, "payers_information": [{"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 9.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 9.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 9.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HYDROMORPHONE (PF) 10 MG/ML INJECTION SOLUTION", "code_information": [{"code": "J1171", "type": "HCPCS"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 26.48, "maximum": 451.29, "gross_charge": 54.6, "discounted_cash": 32.76, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 150.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 296.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 451.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 150.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 296.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 451.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 296.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 451.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HYDROMORPHONE (PF) 10 MG/ML INJECTION SOLUTION|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "J1171", "type": "HCPCS"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 30.03, "maximum": 35.49, "gross_charge": 54.6, "discounted_cash": 32.76, "payers_information": [{"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HYDROMORPHONE (PF) 0.2 MG/ML INJECTION SYRINGE", "code_information": [{"code": "J1171", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.6, "maximum": 12.37, "gross_charge": 14.55, "discounted_cash": 8.73, "payers_information": [{"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HYDROMORPHONE (PF) 0.4 MG/2 ML (0.2 MG/ML) IN NACL, ISO-OSM IV SYRINGE", "code_information": [{"code": "J1171", "type": "HCPCS"}], "drug_information": {"unit": 2, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.2, "maximum": 36.34, "gross_charge": 42.75, "discounted_cash": 25.65, "payers_information": [{"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HYDROMORPHONE 2 MG/ML INJECTION SOLUTION (SO)", "code_information": [{"code": "J1171", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 2.06, "maximum": 18.05, "gross_charge": 4.25, "discounted_cash": 2.55, "payers_information": [{"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HYDROMORPHONE INFUSION/PCA 0.2 MG/ML CASSETTE (PEDIATRICS)", "code_information": [{"code": "J1171", "type": "HCPCS"}], "drug_information": {"unit": 100, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 4.73, "maximum": 180.52, "gross_charge": 36.45, "discounted_cash": 21.87, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 60.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 118.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 180.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 60.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 118.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 180.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 118.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 180.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HYDROMORPHONE INFUSION/PCA 0.2 MG/ML CASSETTE (PEDIATRICS)", "code_information": [{"code": "J1171", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 4.73, "maximum": 180.52, "gross_charge": 9.75, "discounted_cash": 5.85, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 30.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 59.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 90.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 30.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 59.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 90.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 59.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 90.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HYDROMORPHONE INFUSION/PCA 0.2 MG/ML CASSETTE (PEDIATRICS)|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "J1171", "type": "HCPCS"}], "drug_information": {"unit": 100, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 5.36, "maximum": 23.69, "gross_charge": 36.45, "discounted_cash": 21.87, "payers_information": [{"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HYDROMORPHONE INFUSION/PCA 0.2 MG/ML CASSETTE (PEDIATRICS)|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "J1171", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 5.36, "maximum": 23.69, "gross_charge": 9.75, "discounted_cash": 5.85, "payers_information": [{"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HYDROMORPHONE 20 MG/100 ML (0.2 MG/ML) IN 0.9 % NACL IV PUMP RESERVOIR (PEDIATRICS)", "code_information": [{"code": "J1171", "type": "HCPCS"}], "drug_information": {"unit": 100, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 10.48, "maximum": 180.52, "gross_charge": 21.6, "discounted_cash": 12.96, "payers_information": [{"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 118.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 180.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 118.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 180.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 60.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 118.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 180.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 60.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HYDROMORPHONE (PF) 0.2 MG/ML INJECTION SYRINGE (PEDIATRICS)", "code_information": [{"code": "J1171", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.6, "maximum": 12.37, "gross_charge": 14.55, "discounted_cash": 8.73, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DEXRAZOXANE HCL 500 MG INTRAVENOUS SOLUTION", "code_information": [{"code": "J1190", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 116.03, "maximum": 747.98, "gross_charge": 686.5, "discounted_cash": 411.9, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 503.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 510.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 510.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 514.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 510.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 216.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 374.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 354.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 339.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 367.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 490.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 747.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 583.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 583.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 377.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 567.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 116.03, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 116.03, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 374.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 508.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 477.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 446.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 116.03, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 503.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 343.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 518.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 446.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 332.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 116.03, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 514.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 374.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 514.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 549.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 116.03, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 514.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 549.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 216.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 116.03, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 372.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 372.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 514.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 446.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 503.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 503.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 503.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 510.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 398.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 490.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 747.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 583.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 567.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 514.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 518.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 583.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 518.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 446.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 490.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 747.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 567.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 514.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 116.03, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 116.03, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 514.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 372.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 374.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 116.03, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 549.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 116.03, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 116.03, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 510.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 514.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 116.03, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 398.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 514.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DIPHENHYDRAMINE 50 MG/ML INJECTION INJ (SO)", "code_information": [{"code": "J1200", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.48, "maximum": 4.58, "gross_charge": 3.05, "discounted_cash": 1.83, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DIPHENHYDRAMINE 50 MG/ML INJECTION INJ (SO) (PEDIATRICS)", "code_information": [{"code": "J1200", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.48, "maximum": 4.58, "gross_charge": 3.05, "discounted_cash": 1.83, "payers_information": [{"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CHLOROTHIAZIDE SODIUM IV SYRINGE 25 MG/ML (PEDIATRICS)", "code_information": [{"code": "J1205", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 372.1, "maximum": 513.24, "gross_charge": 641.55, "discounted_cash": 384.93, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 409.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 513.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 409.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 372.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 372.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CHLOROTHIAZIDE SODIUM IV SYRINGE 25 MG/ML (PEDIATRICS)|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "J1205", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 248.07, "maximum": 342.16, "gross_charge": 427.7, "discounted_cash": 256.62, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 248.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 248.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 342.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 272.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 272.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CHLOROTHIAZIDE SODIUM 500 MG INTRAVENOUS SOLUTION", "code_information": [{"code": "J1205", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 92.25, "maximum": 136.48, "gross_charge": 159.05, "discounted_cash": 95.43, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 136.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 136.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "METHADONE 10 MG/ML INJECTION SOLUTION", "code_information": [{"code": "J1230", "type": "HCPCS"}], "drug_information": {"unit": 20, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 989.67, "maximum": 2282.24, "gross_charge": 2040.55, "discounted_cash": 1224.33, "payers_information": [{"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 1510.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1418.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 1326.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1114.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1495.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1540.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1326.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 989.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1020.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1530.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1530.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1632.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1530.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1632.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1548.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1105.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1105.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1530.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1326.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1495.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1516.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1183.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1497.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 2282.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 1734.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1685.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1114.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1495.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1495.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1530.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1540.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1734.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1540.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1326.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1497.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 2282.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1685.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1530.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1530.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1105.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1114.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1632.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1516.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1530.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1183.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1530.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1495.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 1516.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1516.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 1530.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1114.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1054.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1008.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1497.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 2282.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1734.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 1734.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1122.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1685.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1516.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1548.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1093.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "METHADONE 10 MG/ML INJECTION SYRINGE", "code_information": [{"code": "J1230", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 65.11, "maximum": 114.11, "gross_charge": 134.25, "discounted_cash": 80.55, "payers_information": [{"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 107.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 74.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 114.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 110.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 74.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 114.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 110.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 107.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 77.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 107.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 77.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 74.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 114.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 110.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "METHADONE 2 MG/ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE (PEDIATRICS)", "code_information": [{"code": "J1230", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 8.9, "maximum": 114.11, "gross_charge": 18.35, "discounted_cash": 11.01, "payers_information": [{"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 77.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 74.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 114.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 74.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 114.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 74.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 114.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 77.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DOBUTAMINE 250 MG/250 ML (1 MG/ML) IN 5 % DEXTROSE INTRAVENOUS", "code_information": [{"code": "J1250", "type": "HCPCS"}], "drug_information": {"unit": 250, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 19.72, "maximum": 51.7, "gross_charge": 40.65, "discounted_cash": 24.39, "payers_information": [{"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 26.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 33.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 51.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 33.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 51.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 26.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 33.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 51.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DOBUTAMINE 1,000 MG/250 ML(4,000 MCG/ML) IN 5 % DEXTROSE IV", "code_information": [{"code": "J1250", "type": "HCPCS"}], "drug_information": {"unit": 250, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 39.04, "maximum": 206.82, "gross_charge": 80.5, "discounted_cash": 48.3, "payers_information": [{"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 135.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 206.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 107.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 135.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 206.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 135.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 206.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 107.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DOBUTAMINE 500 MG/250 ML (2,000 MCG/ML) IN 5 % DEXTROSE IV", "code_information": [{"code": "J1250", "type": "HCPCS"}], "drug_information": {"unit": 250, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 28.59, "maximum": 103.41, "gross_charge": 58.95, "discounted_cash": 35.37, "payers_information": [{"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 53.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 67.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 103.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 67.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 103.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 53.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 67.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 103.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DOPAMINE INFUSION 1.6 MG/ML (PEDIATRICS)", "code_information": [{"code": "J1250", "type": "HCPCS"}], "drug_information": {"unit": 20, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 17.07, "maximum": 51.7, "gross_charge": 35.2, "discounted_cash": 21.12, "payers_information": [{"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 33.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 51.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 33.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 51.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 26.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 33.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 51.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 26.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DOPAMINE INFUSION 3.2 MG/ML (PEDIATRICS)", "code_information": [{"code": "J1250", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 12.32, "maximum": 51.7, "gross_charge": 25.4, "discounted_cash": 15.24, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 26.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 33.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 51.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 26.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 33.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 51.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 33.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 51.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DOBUTAMINE INFUSION 1 MG/ML (PEDIATRICS)", "code_information": [{"code": "J1250", "type": "HCPCS"}], "drug_information": {"unit": 20, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 22.75, "maximum": 51.7, "gross_charge": 46.9, "discounted_cash": 28.14, "payers_information": [{"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 33.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 51.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 33.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 51.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 26.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 33.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 51.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 26.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DOBUTAMINE INFUSION 2 MG/ML (PEDIATRICS)", "code_information": [{"code": "J1250", "type": "HCPCS"}], "drug_information": {"unit": 20, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 16.17, "maximum": 51.7, "gross_charge": 33.35, "discounted_cash": 20.01, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 26.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 33.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 51.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 26.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 33.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 51.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 33.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 51.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DOBUTAMINE INFUSION 4 MG/ML (PEDIATRICS)", "code_information": [{"code": "J1250", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 11.03, "maximum": 51.7, "gross_charge": 22.75, "discounted_cash": 13.65, "payers_information": [{"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 33.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 51.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 33.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 51.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 26.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 33.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 51.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 26.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DOBUTAMINE 250 MG/20 ML (12.5 MG/ML) INTRAVENOUS SOLUTION", "code_information": [{"code": "J1250", "type": "HCPCS"}], "drug_information": {"unit": 20, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 19.5, "maximum": 51.7, "gross_charge": 40.2, "discounted_cash": 24.12, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 26.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 33.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 51.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 26.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 33.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 51.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 33.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 51.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DOPAMINE 400 MG/10 ML (40 MG/ML) INTRAVENOUS SOLUTION", "code_information": [{"code": "J1265", "type": "HCPCS"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 6.26, "maximum": 51.58, "gross_charge": 12.9, "discounted_cash": 7.74, "payers_information": [{"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 22.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 33.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 51.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 22.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 33.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 51.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 33.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 51.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DOPAMINE 200 MG/250 ML (800 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS SOLN", "code_information": [{"code": "J1265", "type": "HCPCS"}], "drug_information": {"unit": 250, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 11.15, "maximum": 37.19, "gross_charge": 43.75, "discounted_cash": 26.25, "payers_information": [{"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 16.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 25.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 16.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 25.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 16.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 25.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DOPAMINE 400 MG/250 ML (1,600 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS SOLN", "code_information": [{"code": "J1265", "type": "HCPCS"}], "drug_information": {"unit": 250, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 21.99, "maximum": 51.58, "gross_charge": 45.35, "discounted_cash": 27.21, "payers_information": [{"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 22.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 33.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 51.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 22.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 33.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 51.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 33.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 51.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DOPAMINE 800 MG/250 ML (3,200 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS SOLN", "code_information": [{"code": "J1265", "type": "HCPCS"}], "drug_information": {"unit": 250, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 36.25, "maximum": 103.15, "gross_charge": 74.75, "discounted_cash": 44.85, "payers_information": [{"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 67.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 67.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 44.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 67.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 44.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DOPAMINE INFUSION 0.8 MG/ML (PEDIATRICS)", "code_information": [{"code": "J1265", "type": "HCPCS"}], "drug_information": {"unit": 250, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 11.15, "maximum": 37.19, "gross_charge": 43.75, "discounted_cash": 26.25, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 16.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 25.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 16.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 25.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 16.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 25.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION", "code_information": [{"code": "J1271", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 29.54, "maximum": 64.47, "gross_charge": 60.9, "discounted_cash": 36.54, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 41.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 42.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 64.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 41.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 42.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 64.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 42.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 64.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ECALLANTIDE 10 MG/ML (1 ML) SUBCUTANEOUS SOLUTION", "code_information": [{"code": "J1290", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 3943.75, "maximum": 19603.7, "gross_charge": 7983.3, "discounted_cash": 4789.98, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5851.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 19603.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3943.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4279.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4390.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5797.46, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5797.46, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4390.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5797.46, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5851.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3991.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5797.46, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6386.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5797.46, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6386.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 19603.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5797.46, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4326.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 5987.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5851.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5851.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5851.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4630.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 5987.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5797.46, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5797.46, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4326.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5797.46, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6386.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5797.46, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5797.46, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5797.46, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4630.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ECULIZUMAB 300 MG/30 ML INTRAVENOUS SOLUTION", "code_information": [{"code": "J1299", "type": "HCPCS"}], "drug_information": {"unit": 30, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 6754.2, "maximum": 43546.26, "gross_charge": 30984.25, "discounted_cash": 18590.55, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22711.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 23021.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 23021.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 23238.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 23021.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 22698.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "fee schedule", "standard_charge_dollar": 8248.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "fee schedule", "standard_charge_dollar": 8248.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "fee schedule", "standard_charge_dollar": 8248.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16607.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 28571.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 43546.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 26336.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 26336.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 17041.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25592.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 6754.2, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 6754.2, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "fee schedule", "standard_charge_dollar": 8248.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 22928.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 21534.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 20139.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 6754.2, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22711.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15492.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23393.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20139.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15027.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 6754.2, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23238.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "fee schedule", "standard_charge_dollar": 8248.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23238.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24787.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 6754.2, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23238.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24787.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 22698.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 6754.2, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16793.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16793.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 23238.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20139.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22711.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22711.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22711.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 23021.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 17970.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 28571.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 43546.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 26336.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25592.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23238.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23393.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26336.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23393.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20139.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 28571.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 43546.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25592.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 23238.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 6754.2, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 6754.2, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23238.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16793.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "fee schedule", "standard_charge_dollar": 8248.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 6754.2, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24787.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 6754.2, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 6754.2, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 23021.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23238.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 6754.2, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 17970.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23238.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION", "code_information": [{"code": "J1308", "type": "HCPCS"}], "drug_information": {"unit": 4, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 4.05, "maximum": 10.32, "gross_charge": 8.35, "discounted_cash": 5.01, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION (USE WITH TPN CALCULATOR)", "code_information": [{"code": "J1308", "type": "HCPCS"}], "drug_information": {"unit": 20, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 11.23, "maximum": 51.58, "gross_charge": 23.15, "discounted_cash": 13.89, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 33.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 51.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 24.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 33.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 51.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 33.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 51.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 24.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ELOSULFASE ALFA 5 MG/5 ML (1 MG/ML) INTRAVENOUS SOLUTION", "code_information": [{"code": "J1322", "type": "HCPCS"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 1559.7, "maximum": 10055.39, "gross_charge": 6781.5, "discounted_cash": 4068.9, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4970.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 5038.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5038.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 5086.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5038.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5184.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "fee schedule", "standard_charge_dollar": 1893.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "fee schedule", "standard_charge_dollar": 1893.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1893.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3634.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6597.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 10055.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 5764.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5764.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3729.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5601.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1559.7, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1559.7, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "fee schedule", "standard_charge_dollar": 1893.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 5018.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4713.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 4407.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1559.7, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4970.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3390.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5120.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4407.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3289.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1559.7, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5086.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "fee schedule", "standard_charge_dollar": 1893.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5086.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5425.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1559.7, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5086.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5425.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5184.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1559.7, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3675.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3675.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 5086.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4407.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4970.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4970.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4970.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5038.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3933.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6597.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 10055.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5764.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5601.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5086.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5120.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5764.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5120.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4407.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6597.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 10055.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5601.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 5086.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1559.7, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1559.7, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5086.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3675.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "fee schedule", "standard_charge_dollar": 1893.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1559.7, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5425.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1559.7, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1559.7, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5038.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5086.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1559.7, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3933.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5086.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "EPOPROSTENOL (VELETRI) 1.5 MG IV SOLR", "code_information": [{"code": "J1325", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 70.56, "maximum": 164.28, "gross_charge": 121.65, "discounted_cash": 72.99, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 164.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 97.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 164.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "EPOPROSTENOL (VELETRI) 0.5 MG IV SOLR", "code_information": [{"code": "J1325", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 35.29, "maximum": 54.76, "gross_charge": 60.85, "discounted_cash": 36.51, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 54.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 54.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ERTAPENEM 1 GRAM SOLUTION FOR INJECTION - IV", "code_information": [{"code": "J1335", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 60.98, "maximum": 121.25, "gross_charge": 142.65, "discounted_cash": 85.59, "payers_information": [{"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 77.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 118.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 121.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 117.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 107.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 121.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 107.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 77.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 118.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 117.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 60.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 77.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 118.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 121.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 121.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 117.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 107.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 60.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ERTAPENEM 1 GRAM SOLUTION FOR INJECTION - IV|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "J1335", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 87.02, "maximum": 87.02, "gross_charge": 142.65, "discounted_cash": 85.59, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DELANDISTROGENE MOXEPARVOVEC-ROKL 1.33X10EXP13 VG/ML INTRAVENOUS SUSP-220 ML", "code_information": [{"code": "J1413", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.04, "maximum": 11237053.02, "gross_charge": 6400000.0, "discounted_cash": 3840000.0, "payers_information": [{"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 4736000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4448000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3200000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3104000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11237053.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3308800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3161600.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3712000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5120000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11237053.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3712000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DELANDISTROGENE MOXEPARVOVEC-ROKL 1.33X10EXP13 VG/ML INTRAVENOUS SUSP-100 ML", "code_information": [{"code": "J1413", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.04, "maximum": 11237053.02, "gross_charge": 6400000.0, "discounted_cash": 3840000.0, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3712000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5120000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11237053.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3712000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3308800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3161600.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11237053.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3104000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3200000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 4736000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4448000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DELANDISTROGENE MOXEPARVOVEC-ROKL 1.33X10EXP13 VG/ML INTRAVENOUS SUSP-110 ML", "code_information": [{"code": "J1413", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.04, "maximum": 11237053.02, "gross_charge": 6400000.0, "discounted_cash": 3840000.0, "payers_information": [{"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 4736000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4448000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3200000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3104000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11237053.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3308800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3161600.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3712000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5120000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11237053.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3712000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DELANDISTROGENE MOXEPARVOVEC-ROKL 1.33X10EXP13 VG/ML INTRAVENOUS SUSP-120 ML", "code_information": [{"code": "J1413", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.04, "maximum": 11237053.02, "gross_charge": 6400000.0, "discounted_cash": 3840000.0, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3712000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5120000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11237053.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3712000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3308800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3161600.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11237053.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3104000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3200000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 4736000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4448000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DELANDISTROGENE MOXEPARVOVEC-ROKL 1.33X10EXP13 VG/ML INTRAVENOUS SUSP-130 ML", "code_information": [{"code": "J1413", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.04, "maximum": 11237053.02, "gross_charge": 6400000.0, "discounted_cash": 3840000.0, "payers_information": [{"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 4736000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4448000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3200000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3104000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11237053.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3308800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3161600.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3712000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5120000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11237053.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3712000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DELANDISTROGENE MOXEPARVOVEC-ROKL 1.33X10EXP13 VG/ML INTRAVENOUS SUSP-140 ML", "code_information": [{"code": "J1413", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.04, "maximum": 11237053.02, "gross_charge": 6400000.0, "discounted_cash": 3840000.0, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3712000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5120000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11237053.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3712000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3308800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3161600.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11237053.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3104000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3200000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 4736000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4448000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DELANDISTROGENE MOXEPARVOVEC-ROKL 1.33X10EXP13 VG/ML INTRAVENOUS SUSP-150 ML", "code_information": [{"code": "J1413", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.04, "maximum": 11237053.02, "gross_charge": 6400000.0, "discounted_cash": 3840000.0, "payers_information": [{"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 4736000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4448000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3200000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3104000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11237053.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3308800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3161600.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3712000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5120000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11237053.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3712000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DELANDISTROGENE MOXEPARVOVEC-ROKL 1.33X10EXP13 VG/ML INTRAVENOUS SUSP-160 ML", "code_information": [{"code": "J1413", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.04, "maximum": 11237053.02, "gross_charge": 6400000.0, "discounted_cash": 3840000.0, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3712000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5120000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11237053.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3712000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3308800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3161600.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11237053.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3104000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3200000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 4736000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4448000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DELANDISTROGENE MOXEPARVOVEC-ROKL 1.33X10EXP13 VG/ML INTRAVENOUS SUSP-170 ML", "code_information": [{"code": "J1413", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.04, "maximum": 11237053.02, "gross_charge": 6400000.0, "discounted_cash": 3840000.0, "payers_information": [{"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 4736000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4448000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3200000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3104000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11237053.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3308800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3161600.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3712000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5120000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11237053.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3712000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DELANDISTROGENE MOXEPARVOVEC-ROKL 1.33X10EXP13 VG/ML INTRAVENOUS SUSP-180 ML", "code_information": [{"code": "J1413", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.04, "maximum": 11237053.02, "gross_charge": 6400000.0, "discounted_cash": 3840000.0, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3712000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5120000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11237053.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3712000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3308800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3161600.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11237053.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3104000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3200000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 4736000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4448000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DELANDISTROGENE MOXEPARVOVEC-ROKL 1.33X10EXP13 VG/ML INTRAVENOUS SUSP-190 ML", "code_information": [{"code": "J1413", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.04, "maximum": 11237053.02, "gross_charge": 6400000.0, "discounted_cash": 3840000.0, "payers_information": [{"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 4736000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4448000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3200000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3104000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11237053.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3308800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3161600.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3712000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5120000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11237053.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3712000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DELANDISTROGENE MOXEPARVOVEC-ROKL 1.33X10EXP13 VG/ML INTRAVENOUS SUSP-200 ML", "code_information": [{"code": "J1413", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.04, "maximum": 11237053.02, "gross_charge": 6400000.0, "discounted_cash": 3840000.0, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3712000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5120000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11237053.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3712000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3308800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3161600.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11237053.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3104000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3200000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 4736000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4448000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DELANDISTROGENE MOXEPARVOVEC-ROKL 1.33X10EXP13 VG/ML INTRAVENOUS SUSP-210 ML", "code_information": [{"code": "J1413", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.04, "maximum": 11237053.02, "gross_charge": 6400000.0, "discounted_cash": 3840000.0, "payers_information": [{"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 4736000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4448000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3200000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3104000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11237053.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3308800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3161600.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3712000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5120000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11237053.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3712000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DELANDISTROGENE MOXEPARVOVEC-ROKL 1.33X10EXP13 VG/ML INTRAVENOUS SUSP-230 ML", "code_information": [{"code": "J1413", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.04, "maximum": 11237053.02, "gross_charge": 6400000.0, "discounted_cash": 3840000.0, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3712000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5120000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11237053.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3712000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3308800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3161600.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11237053.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3104000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3200000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 4736000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4448000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DELANDISTROGENE MOXEPARVOVEC-ROKL 1.33X10EXP13 VG/ML INTRAVENOUS SUSP-240 ML", "code_information": [{"code": "J1413", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.04, "maximum": 11237053.02, "gross_charge": 6400000.0, "discounted_cash": 3840000.0, "payers_information": [{"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 4736000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4448000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3200000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3104000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11237053.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3308800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3161600.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3712000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5120000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11237053.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3712000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DELANDISTROGENE MOXEPARVOVEC-ROKL 1.33X10EXP13 VG/ML INTRAVENOUS SUSP-250 ML", "code_information": [{"code": "J1413", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.04, "maximum": 11237053.02, "gross_charge": 6400000.0, "discounted_cash": 3840000.0, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3712000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5120000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11237053.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3712000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3308800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3161600.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11237053.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3104000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3200000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 4736000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4448000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DELANDISTROGENE MOXEPARVOVEC-ROKL 1.33X10EXP13 VG/ML INTRAVENOUS SUSP-260 ML", "code_information": [{"code": "J1413", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.04, "maximum": 11237053.02, "gross_charge": 6400000.0, "discounted_cash": 3840000.0, "payers_information": [{"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 4736000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4448000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3200000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3104000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11237053.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3308800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3161600.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3712000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5120000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11237053.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3712000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DELANDISTROGENE MOXEPARVOVEC-ROKL 1.33X10EXP13 VG/ML INTRAVENOUS SUSP-270 ML", "code_information": [{"code": "J1413", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.04, "maximum": 11237053.02, "gross_charge": 6400000.0, "discounted_cash": 3840000.0, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3712000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5120000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11237053.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3712000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3308800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3161600.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11237053.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3104000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3200000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 4736000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4448000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DELANDISTROGENE MOXEPARVOVEC-ROKL 1.33X10EXP13 VG/ML INTRAVENOUS SUSP-280 ML", "code_information": [{"code": "J1413", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.04, "maximum": 11237053.02, "gross_charge": 6400000.0, "discounted_cash": 3840000.0, "payers_information": [{"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 4736000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4448000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3200000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3104000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11237053.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3308800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3161600.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3712000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5120000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11237053.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3712000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DELANDISTROGENE MOXEPARVOVEC-ROKL 1.33X10EXP13 VG/ML INTRAVENOUS SUSP-290 ML", "code_information": [{"code": "J1413", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.04, "maximum": 11237053.02, "gross_charge": 6400000.0, "discounted_cash": 3840000.0, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3712000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5120000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11237053.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3712000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3308800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3161600.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11237053.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3104000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3200000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 4736000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4448000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DELANDISTROGENE MOXEPARVOVEC-ROKL 1.33X10EXP13 VG/ML INTRAVENOUS SUSP-300 ML", "code_information": [{"code": "J1413", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.04, "maximum": 11237053.02, "gross_charge": 6400000.0, "discounted_cash": 3840000.0, "payers_information": [{"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 4736000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4448000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3200000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3104000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11237053.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3308800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3161600.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3712000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3712000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5120000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11237053.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DELANDISTROGENE MOXEPARVOVEC-ROKL 1.33X10EXP13 VG/ML INTRAVENOUS SUSP-310 ML", "code_information": [{"code": "J1413", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.04, "maximum": 11237053.02, "gross_charge": 6400000.0, "discounted_cash": 3840000.0, "payers_information": [{"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5120000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11237053.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3712000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3712000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3308800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3161600.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11237053.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3104000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3200000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 4736000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4448000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DELANDISTROGENE MOXEPARVOVEC-ROKL 1.33X10EXP13 VG/ML INTRAVENOUS SUSP-320 ML", "code_information": [{"code": "J1413", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.04, "maximum": 11237053.02, "gross_charge": 6400000.0, "discounted_cash": 3840000.0, "payers_information": [{"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 4736000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4448000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3200000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3104000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11237053.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3308800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3161600.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3712000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3712000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5120000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11237053.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DELANDISTROGENE MOXEPARVOVEC-ROKL 1.33X10EXP13 VG/ML INTRAVENOUS SUSP-330 ML", "code_information": [{"code": "J1413", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.04, "maximum": 11237053.02, "gross_charge": 6400000.0, "discounted_cash": 3840000.0, "payers_information": [{"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5120000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11237053.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3712000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3712000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3308800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3161600.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11237053.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3104000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3200000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 4736000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4448000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DELANDISTROGENE MOXEPARVOVEC-ROKL 1.33X10EXP13 VG/ML INTRAVENOUS SUSP-340 ML", "code_information": [{"code": "J1413", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.04, "maximum": 11237053.02, "gross_charge": 6400000.0, "discounted_cash": 3840000.0, "payers_information": [{"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 4736000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4448000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3200000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3104000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11237053.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3308800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3161600.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3712000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3712000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5120000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11237053.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DELANDISTROGENE MOXEPARVOVEC-ROKL 1.33X10EXP13 VG/ML INTRAVENOUS SUSP-350 ML", "code_information": [{"code": "J1413", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.04, "maximum": 11237053.02, "gross_charge": 6400000.0, "discounted_cash": 3840000.0, "payers_information": [{"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5120000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11237053.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3712000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3712000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3308800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3161600.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11237053.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3104000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3200000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 4736000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4448000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DELANDISTROGENE MOXEPARVOVEC-ROKL 1.33X10EXP13 VG/ML INTRAVENOUS SUSP-360 ML", "code_information": [{"code": "J1413", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.04, "maximum": 11237053.02, "gross_charge": 6400000.0, "discounted_cash": 3840000.0, "payers_information": [{"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 4736000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4448000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3200000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3104000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11237053.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3308800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3161600.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3712000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3712000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5120000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11237053.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DELANDISTROGENE MOXEPARVOVEC-ROKL 1.33X10EXP13 VG/ML INTRAVENOUS SUSP-370 ML", "code_information": [{"code": "J1413", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.04, "maximum": 11237053.02, "gross_charge": 6400000.0, "discounted_cash": 3840000.0, "payers_information": [{"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5120000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11237053.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3712000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3712000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3308800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3161600.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11237053.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3104000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3200000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 4736000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4448000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DELANDISTROGENE MOXEPARVOVEC-ROKL 1.33X10EXP13 VG/ML INTRAVENOUS SUSP-380 ML", "code_information": [{"code": "J1413", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.04, "maximum": 11237053.02, "gross_charge": 6400000.0, "discounted_cash": 3840000.0, "payers_information": [{"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 4736000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4448000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3200000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3104000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11237053.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3308800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3161600.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3712000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3712000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5120000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11237053.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DELANDISTROGENE MOXEPARVOVEC-ROKL 1.33X10EXP13 VG/ML INTRAVENOUS SUSP-390 ML", "code_information": [{"code": "J1413", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.04, "maximum": 11237053.02, "gross_charge": 6400000.0, "discounted_cash": 3840000.0, "payers_information": [{"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5120000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11237053.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3712000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3712000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3308800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3161600.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11237053.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3104000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3200000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 4736000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4448000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DELANDISTROGENE MOXEPARVOVEC-ROKL 1.33X10EXP13 VG/ML INTRAVENOUS SUSP-400 ML", "code_information": [{"code": "J1413", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.04, "maximum": 11237053.02, "gross_charge": 6400000.0, "discounted_cash": 3840000.0, "payers_information": [{"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 4736000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4448000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3200000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3104000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11237053.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3308800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3161600.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3712000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3712000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5120000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11237053.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DELANDISTROGENE MOXEPARVOVEC-ROKL 1.33X10EXP13 VG/ML INTRAVENOUS SUSP-410 ML", "code_information": [{"code": "J1413", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.04, "maximum": 11237053.02, "gross_charge": 6400000.0, "discounted_cash": 3840000.0, "payers_information": [{"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5120000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11237053.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3712000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3712000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3308800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3161600.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11237053.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3104000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3200000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 4736000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4448000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DELANDISTROGENE MOXEPARVOVEC-ROKL 1.33X10EXP13 VG/ML INTRAVENOUS SUSP-420 ML", "code_information": [{"code": "J1413", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.04, "maximum": 11237053.02, "gross_charge": 6400000.0, "discounted_cash": 3840000.0, "payers_information": [{"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 4736000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4448000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3308800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3161600.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3200000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3104000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11237053.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3712000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3712000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5120000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11237053.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DELANDISTROGENE MOXEPARVOVEC-ROKL 1.33X10EXP13 VG/ML INTRAVENOUS SUSP-430 ML", "code_information": [{"code": "J1413", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.04, "maximum": 11237053.02, "gross_charge": 6400000.0, "discounted_cash": 3840000.0, "payers_information": [{"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5120000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11237053.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3712000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3712000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11237053.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3104000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3200000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3308800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3161600.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 4736000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4448000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DELANDISTROGENE MOXEPARVOVEC-ROKL 1.33X10EXP13 VG/ML INTRAVENOUS SUSP-440 ML", "code_information": [{"code": "J1413", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.04, "maximum": 11237053.02, "gross_charge": 6400000.0, "discounted_cash": 3840000.0, "payers_information": [{"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 4736000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4448000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3308800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3161600.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3200000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3104000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11237053.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3712000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3712000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5120000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11237053.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DELANDISTROGENE MOXEPARVOVEC-ROKL 1.33X10EXP13 VG/ML INTRAVENOUS SUSP-450 ML", "code_information": [{"code": "J1413", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.04, "maximum": 11237053.02, "gross_charge": 6400000.0, "discounted_cash": 3840000.0, "payers_information": [{"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5120000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11237053.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3712000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3712000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11237053.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3104000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3200000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3308800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3161600.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 4736000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4448000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DELANDISTROGENE MOXEPARVOVEC-ROKL 1.33X10EXP13 VG/ML INTRAVENOUS SUSP-460 ML", "code_information": [{"code": "J1413", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.04, "maximum": 11237053.02, "gross_charge": 6400000.0, "discounted_cash": 3840000.0, "payers_information": [{"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 4736000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4448000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3308800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3161600.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3200000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3104000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11237053.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3712000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3712000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5120000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11237053.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DELANDISTROGENE MOXEPARVOVEC-ROKL 1.33X10EXP13 VG/ML INTRAVENOUS SUSP-470 ML", "code_information": [{"code": "J1413", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.04, "maximum": 11237053.02, "gross_charge": 6400000.0, "discounted_cash": 3840000.0, "payers_information": [{"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5120000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11237053.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3712000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3712000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11237053.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3200000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3104000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3308800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3161600.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 4736000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4448000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DELANDISTROGENE MOXEPARVOVEC-ROKL 1.33X10EXP13 VG/ML INTRAVENOUS SUSP-480 ML", "code_information": [{"code": "J1413", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.04, "maximum": 11237053.02, "gross_charge": 6400000.0, "discounted_cash": 3840000.0, "payers_information": [{"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 4736000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4448000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3308800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3161600.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3104000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3200000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11237053.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3712000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3712000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5120000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11237053.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DELANDISTROGENE MOXEPARVOVEC-ROKL 1.33X10EXP13 VG/ML INTRAVENOUS SUSP-490 ML", "code_information": [{"code": "J1413", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.04, "maximum": 11237053.02, "gross_charge": 6400000.0, "discounted_cash": 3840000.0, "payers_information": [{"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5120000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11237053.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3712000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3712000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11237053.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3200000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3104000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3308800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3161600.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 4736000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4448000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DELANDISTROGENE MOXEPARVOVEC-ROKL 1.33X10EXP13 VG/ML INTRAVENOUS SUSP-500 ML", "code_information": [{"code": "J1413", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.04, "maximum": 11237053.02, "gross_charge": 6400000.0, "discounted_cash": 3840000.0, "payers_information": [{"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 4736000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4448000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3308800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3161600.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3104000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3200000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11237053.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3712000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3712000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5120000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11237053.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DELANDISTROGENE MOXEPARVOVEC-ROKL 1.33X10EXP13 VG/ML INTRAVENOUS SUSP-510 ML", "code_information": [{"code": "J1413", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.04, "maximum": 11237053.02, "gross_charge": 6400000.0, "discounted_cash": 3840000.0, "payers_information": [{"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5120000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11237053.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3712000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3712000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11237053.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3200000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3104000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3308800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3161600.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 4736000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4448000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DELANDISTROGENE MOXEPARVOVEC-ROKL 1.33X10EXP13 VG/ML INTRAVENOUS SUSP-520 ML", "code_information": [{"code": "J1413", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.04, "maximum": 11237053.02, "gross_charge": 6400000.0, "discounted_cash": 3840000.0, "payers_information": [{"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 4736000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4448000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3308800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3161600.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3104000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3200000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11237053.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3712000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3712000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5120000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11237053.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DELANDISTROGENE MOXEPARVOVEC-ROKL 1.33X10EXP13 VG/ML INTRAVENOUS SUSP-530 ML", "code_information": [{"code": "J1413", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.04, "maximum": 11237053.02, "gross_charge": 6400000.0, "discounted_cash": 3840000.0, "payers_information": [{"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5120000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11237053.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3712000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3712000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11237053.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3200000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3104000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3308800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3161600.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 4736000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4448000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DELANDISTROGENE MOXEPARVOVEC-ROKL 1.33X10EXP13 VG/ML INTRAVENOUS SUSP-540 ML", "code_information": [{"code": "J1413", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.04, "maximum": 11237053.02, "gross_charge": 6400000.0, "discounted_cash": 3840000.0, "payers_information": [{"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 4736000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4448000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3308800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3161600.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3104000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3200000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11237053.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3712000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3712000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5120000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11237053.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DELANDISTROGENE MOXEPARVOVEC-ROKL 1.33X10EXP13 VG/ML INTRAVENOUS SUSP-550 ML", "code_information": [{"code": "J1413", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.04, "maximum": 11237053.02, "gross_charge": 6400000.0, "discounted_cash": 3840000.0, "payers_information": [{"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5120000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11237053.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3712000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3712000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11237053.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3200000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3104000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3308800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3161600.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 4736000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4448000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DELANDISTROGENE MOXEPARVOVEC-ROKL 1.33X10EXP13 VG/ML INTRAVENOUS SUSP-560 ML", "code_information": [{"code": "J1413", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.04, "maximum": 11237053.02, "gross_charge": 6400000.0, "discounted_cash": 3840000.0, "payers_information": [{"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 4736000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4448000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3308800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3161600.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3104000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3200000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11237053.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3712000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3712000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5120000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11237053.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DELANDISTROGENE MOXEPARVOVEC-ROKL 1.33X10EXP13 VG/ML INTRAVENOUS SUSP-570 ML", "code_information": [{"code": "J1413", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.04, "maximum": 11237053.02, "gross_charge": 6400000.0, "discounted_cash": 3840000.0, "payers_information": [{"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5120000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11237053.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3712000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3712000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11237053.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3200000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3104000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3308800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3161600.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 4736000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4448000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DELANDISTROGENE MOXEPARVOVEC-ROKL 1.33X10EXP13 VG/ML INTRAVENOUS SUSP-580 ML", "code_information": [{"code": "J1413", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.04, "maximum": 11237053.02, "gross_charge": 6400000.0, "discounted_cash": 3840000.0, "payers_information": [{"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 4736000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4448000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3308800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3161600.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3104000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3200000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11237053.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3712000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3712000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5120000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11237053.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DELANDISTROGENE MOXEPARVOVEC-ROKL 1.33X10EXP13 VG/ML INTRAVENOUS SUSP-590 ML", "code_information": [{"code": "J1413", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.04, "maximum": 11237053.02, "gross_charge": 6400000.0, "discounted_cash": 3840000.0, "payers_information": [{"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5120000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11237053.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3712000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3712000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11237053.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3200000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3104000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3308800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3161600.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 4736000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4448000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DELANDISTROGENE MOXEPARVOVEC-ROKL 1.33X10EXP13 VG/ML INTRAVENOUS SUSP-600 ML", "code_information": [{"code": "J1413", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.04, "maximum": 11237053.02, "gross_charge": 6400000.0, "discounted_cash": 3840000.0, "payers_information": [{"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 4736000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4448000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3308800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3161600.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3104000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3200000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4832000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11237053.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3712000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5440000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4755200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3712000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3494400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3327859.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4800000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5120000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11237053.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4160000.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3468800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4691200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5286400.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "VILTOLARSEN 50 MG/ML INTRAVENOUS SOLUTION", "code_information": [{"code": "J1427", "type": "HCPCS"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 1154.79, "maximum": 9090.27, "gross_charge": 6345.0, "discounted_cash": 3807.0, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4650.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 4714.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4714.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 4758.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4714.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5719.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "fee schedule", "standard_charge_dollar": 1764.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "fee schedule", "standard_charge_dollar": 1764.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1764.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3400.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5964.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 9090.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 5393.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5393.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3489.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5240.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1307.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1154.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "fee schedule", "standard_charge_dollar": 1764.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 4695.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4409.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 4124.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4650.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3172.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4790.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4124.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3077.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4758.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "fee schedule", "standard_charge_dollar": 1764.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4758.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5076.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4758.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5076.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5719.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1484.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3438.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3438.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 4758.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4124.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4650.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4650.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4650.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4714.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3680.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5964.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 9090.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5393.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5240.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4758.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4790.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5393.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4790.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4124.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5964.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 9090.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5240.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 4758.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1484.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1484.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4758.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3438.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "fee schedule", "standard_charge_dollar": 1764.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1484.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5076.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4714.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4758.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3680.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4758.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ETHANOLAMINE OLEATE 5 % INTRAVENOUS SOLUTION", "code_information": [{"code": "J1430", "type": "HCPCS"}], "drug_information": {"unit": 2, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 517.08, "maximum": 1755.98, "gross_charge": 1958.3, "discounted_cash": 1174.98, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1135.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1468.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 517.08, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 517.08, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1061.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 517.08, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1566.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 517.08, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 517.08, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 517.08, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1135.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1435.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1755.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 967.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1049.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1077.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 517.08, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 517.08, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1077.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 517.08, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1435.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 979.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 517.08, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1566.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 517.08, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1566.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1755.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 517.08, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1061.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1468.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1435.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1435.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1435.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ETANERCEPT 25 MG/0.5 ML SUBCUTANEOUS SOLUTION", "code_information": [{"code": "J1438", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "minimum": 805.91, "maximum": 6574.01, "gross_charge": 4428.1, "discounted_cash": 2656.86, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3245.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 3290.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3290.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 3321.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3290.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3653.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2417.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2289.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2187.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2373.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4313.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 6574.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 3763.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 3763.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2435.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3657.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 912.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 805.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2417.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 3276.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 3077.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 2878.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3245.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2214.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3343.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2878.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2147.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3321.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2417.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3321.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3542.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3321.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3542.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3653.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1036.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2400.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2400.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3321.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2878.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3245.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3245.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3245.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3290.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2568.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4313.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 6574.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 3763.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3657.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3321.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3343.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3763.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3343.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2878.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4313.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 6574.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3657.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3321.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1036.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1036.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3321.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2400.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2417.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1036.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3542.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3290.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3321.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2568.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3321.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FERRIC CARBOXYMALTOSE 50 MG IRON/ML INTRAVENOUS SOLUTION", "code_information": [{"code": "J1439", "type": "HCPCS"}], "drug_information": {"unit": 15, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 836.25, "maximum": 5415.48, "gross_charge": 4579.2, "discounted_cash": 2747.52, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2655.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3553.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 5415.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 3892.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3782.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3434.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3457.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3892.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3457.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2976.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3553.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 5415.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3782.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3434.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 836.25, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 836.25, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3434.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2481.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2500.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 836.25, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3663.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 836.25, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 836.25, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3402.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3434.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 836.25, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2655.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3434.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2887.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2500.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2367.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2262.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2454.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3553.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 5415.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 3892.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 3892.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2518.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3782.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 836.25, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 836.25, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2500.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 3388.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 3182.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 2976.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 836.25, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3356.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2289.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3457.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2976.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2220.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 836.25, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3434.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2500.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3434.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3663.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 836.25, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3434.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3663.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2887.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 836.25, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2481.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2481.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3434.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2976.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3356.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3356.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3356.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3402.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3356.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 3402.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3402.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 3434.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3402.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FILGRASTIM 300 MCG/ML INJECTION SOLUTION", "code_information": [{"code": "J1442", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 299.1, "maximum": 1934.1, "gross_charge": 1289.95, "discounted_cash": 773.97, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 945.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 958.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 958.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 967.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 958.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1005.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 704.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 666.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 637.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 691.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1269.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1934.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1096.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 1096.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 709.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1065.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 299.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 299.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 704.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 838.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 767.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 709.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 299.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 945.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 644.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 973.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 838.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 625.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 299.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 967.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 704.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 967.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1031.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 299.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 786.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1031.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1005.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 299.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 699.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 699.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 967.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 838.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 945.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 945.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 945.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 958.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 748.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1269.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1934.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 1096.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1065.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 967.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 973.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1096.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 973.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 838.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1269.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1934.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1065.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 967.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 299.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 299.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 967.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 699.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 704.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 299.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1031.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 299.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 299.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 958.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 967.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 299.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 748.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 967.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK", "code_information": [{"code": "J1450", "type": "HCPCS"}], "drug_information": {"unit": 100, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 7.64, "maximum": 28.88, "gross_charge": 25.0, "discounted_cash": 15.0, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 18.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 28.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 18.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 28.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 18.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 28.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FLUCONAZOLE IV SYRINGE 2 MG/ML (PEDIATRICS)", "code_information": [{"code": "J1450", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 7.64, "maximum": 31.58, "gross_charge": 37.15, "discounted_cash": 22.29, "payers_information": [{"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 18.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 28.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 18.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 28.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 18.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 28.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FOMEPIZOLE 1 GRAM/ML INTRAVENOUS SOLUTION", "code_information": [{"code": "J1451", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 643.4, "maximum": 8013.62, "gross_charge": 2342.95, "discounted_cash": 1405.77, "payers_information": [{"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 643.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1757.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1279.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1757.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1874.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 643.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1757.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1874.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2038.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 643.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1269.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1269.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1757.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1522.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1717.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1717.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1717.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1740.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1358.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5257.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 8013.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 1991.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1935.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1757.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1768.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1991.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1768.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1522.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5257.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 8013.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1935.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1757.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 643.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 643.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1757.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1269.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1279.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 643.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1874.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 643.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 643.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1740.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1757.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 643.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1358.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1757.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1717.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 1740.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1740.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 1757.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1740.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2038.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1279.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1211.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1157.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1255.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5257.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 8013.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1991.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 1991.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1288.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1935.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 643.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 643.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1279.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 1733.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1628.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 1522.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 643.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1717.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1171.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1768.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1522.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1136.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FOSCARNET 24 MG/ML INTRAVENOUS SOLUTION - CENTRAL LINE ONLY", "code_information": [{"code": "J1455", "type": "HCPCS"}], "drug_information": {"unit": 250, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 170.3, "maximum": 688.5, "gross_charge": 810.0, "discounted_cash": 486.0, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 593.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 601.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 601.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 607.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 601.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 315.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 442.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 418.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 400.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 434.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 170.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 259.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 688.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 688.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 445.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 669.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 442.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 526.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 481.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 445.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 593.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 405.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 611.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 526.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 392.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 607.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 442.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 607.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 648.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 494.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 648.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 315.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 439.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 439.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 607.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 526.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 593.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 593.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 593.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 601.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 469.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 170.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 259.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 688.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 669.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 607.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 611.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 688.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 611.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 526.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 170.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 259.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 669.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 607.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 607.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 439.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 442.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 648.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 601.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 607.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 469.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 607.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "GALSULFASE 5 MG/5 ML INTRAVENOUS SOLUTION", "code_information": [{"code": "J1458", "type": "HCPCS"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 2569.3, "maximum": 16564.28, "gross_charge": 11191.5, "discounted_cash": 6714.9, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8203.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 8315.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 8315.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 8393.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 8315.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8543.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "fee schedule", "standard_charge_dollar": 3121.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "fee schedule", "standard_charge_dollar": 3121.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "fee schedule", "standard_charge_dollar": 3121.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5998.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 10868.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 16564.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 9512.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 9512.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 6155.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9244.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2569.3, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2569.3, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "fee schedule", "standard_charge_dollar": 3121.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 8281.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 7778.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 7274.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2569.3, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8203.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5595.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8449.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7274.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5427.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2569.3, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8393.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "fee schedule", "standard_charge_dollar": 3121.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8393.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8953.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2569.3, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8393.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8953.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8543.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2569.3, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6065.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6065.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 8393.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7274.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8203.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8203.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8203.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 8315.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6491.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 10868.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 16564.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 9512.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9244.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8393.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8449.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9512.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8449.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7274.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 10868.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 16564.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9244.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 8393.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2569.3, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2569.3, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8393.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6065.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "fee schedule", "standard_charge_dollar": 3121.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2569.3, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8953.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2569.3, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2569.3, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 8315.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8393.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2569.3, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6491.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8393.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "IMMUNE GLOBULIN, HUMAN (GAMASTAN) (15-18%) INTRAMUSCULAR SOLUTION", "code_information": [{"code": "J1460", "type": "HCPCS"}], "drug_information": {"unit": 2, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 499.23, "maximum": 1955.52, "gross_charge": 2444.4, "discounted_cash": 1466.64, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1791.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1636.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1207.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1310.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1344.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 499.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 499.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1344.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 499.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1791.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 627.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 499.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1955.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 499.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1955.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1636.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 499.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1324.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1833.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1791.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1791.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1791.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1417.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1833.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 499.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 499.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1324.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 499.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1955.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 499.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 499.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 499.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1417.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "IMMUNE GLOBULIN, HUMAN (HIZENTRA) 1 G/5 ML (20%) SUBCUTANEOUS SOLUTION", "code_information": [{"code": "J1559", "type": "HCPCS"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 145.43, "maximum": 532.76, "gross_charge": 665.95, "discounted_cash": 399.57, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 386.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 532.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 145.43, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 145.43, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 145.43, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 526.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 474.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 328.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 496.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 366.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 145.43, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 145.43, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 366.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 145.43, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 526.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 300.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 532.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 145.43, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 532.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 145.43, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 474.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 145.43, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 360.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 499.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 526.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 526.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 386.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 526.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 499.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 145.43, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 145.43, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 360.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 145.43, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "IMMUNE GLOBULIN, HUMAN (HIZENTRA) 4 G/20 ML (20%) SUBCUTANEOUS SOLUTION", "code_information": [{"code": "J1559", "type": "HCPCS"}], "drug_information": {"unit": 20, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 581.72, "maximum": 1909.2, "gross_charge": 2383.25, "discounted_cash": 1429.95, "payers_information": [{"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 581.72, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1291.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 581.72, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 581.72, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1787.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1746.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1746.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1382.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1746.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1787.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1291.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 581.72, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1906.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1909.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 581.72, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1906.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 581.72, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1200.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1746.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 581.72, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1310.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 581.72, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 581.72, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1310.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1277.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1177.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1909.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1746.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 581.72, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 581.72, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 581.72, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1906.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1382.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "IMMUNE GLOBULIN, HUMAN (GAMUNEX-C,GAMMAKED) 5 G/50 ML (10%) SOLUTION", "code_information": [{"code": "J1561", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 490.76, "maximum": 3164.19, "gross_charge": 1501.55, "discounted_cash": 900.93, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1100.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 1115.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1115.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 1126.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 819.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 776.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 741.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1115.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1623.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 804.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2076.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 3164.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1276.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 1276.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 825.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1240.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 1111.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1043.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 976.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 490.76, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 490.76, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 819.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 490.76, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1133.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 976.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 728.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1100.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 963.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 490.76, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1126.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1126.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1201.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 819.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 490.76, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1126.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1201.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1623.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 813.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 813.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1126.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 976.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1100.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1115.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 870.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2076.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 3164.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 1276.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1240.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 490.76, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1100.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1100.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1126.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1133.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1276.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1133.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 976.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2076.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 3164.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1240.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1126.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 490.76, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 490.76, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1126.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1201.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 813.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 819.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 490.76, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 490.76, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 490.76, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1115.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1126.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 490.76, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 870.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1126.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "IMMUNE GLOBULIN, HUMAN (GAMUNEX-C,GAMMAKED) 10 G/100 ML (10%) SOLUTION", "code_information": [{"code": "J1561", "type": "HCPCS"}], "drug_information": {"unit": 100, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 981.52, "maximum": 6328.38, "gross_charge": 3003.05, "discounted_cash": 1801.83, "payers_information": [{"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2252.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1741.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 981.52, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2252.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2231.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 981.52, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 981.52, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 981.52, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2402.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1639.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1627.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2252.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 981.52, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 981.52, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2252.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4152.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 6328.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2480.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2267.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1951.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2552.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2267.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2252.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2201.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2201.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 981.52, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4152.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 6328.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 2552.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2480.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2201.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2231.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1741.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2252.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1951.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1627.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1627.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2252.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2402.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3246.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 981.52, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1639.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2252.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2402.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2252.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 981.52, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1927.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2201.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2267.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1951.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1456.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 981.52, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1639.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 981.52, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 981.52, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 2222.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 2087.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 1951.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4152.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 6328.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 2552.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 2552.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1651.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2480.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1609.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2231.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3246.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1639.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1552.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1483.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2201.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 2231.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2231.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 2252.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "IMMUNE GLOBULIN, HUMAN (GAMUNEX-C,GAMMAKED) 20 G/200 ML (10%) SOLUTION", "code_information": [{"code": "J1561", "type": "HCPCS"}], "drug_information": {"unit": 200, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 1963.04, "maximum": 12656.75, "gross_charge": 6006.1, "discounted_cash": 3603.66, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4402.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 4462.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4462.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 4504.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3279.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3105.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2967.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4462.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6493.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3219.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8304.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 12656.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 5105.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5105.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3303.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4961.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 4444.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4174.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 3903.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1963.04, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1963.04, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3279.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1963.04, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4534.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3903.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2912.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4402.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3854.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1963.04, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4504.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4504.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4804.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3279.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1963.04, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4504.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4804.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6493.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3255.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3255.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 4504.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3903.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4402.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4462.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3483.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8304.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 12656.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5105.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4961.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1963.04, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4402.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4402.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4504.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4534.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5105.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4534.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3903.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8304.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 12656.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4961.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 4504.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1963.04, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1963.04, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4504.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3255.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3279.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4804.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1963.04, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1963.04, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1963.04, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4462.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4504.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1963.04, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3483.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4504.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "IMMUNE GLOBULIN, HUMAN (GAMMAGARD S-D) 5 G/100 ML (5% RECONSTITUTION)", "code_information": [{"code": "J1566", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 788.92, "maximum": 5086.04, "gross_charge": 3398.85, "discounted_cash": 2039.31, "payers_information": [{"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2525.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2549.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 788.92, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1971.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 788.92, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2549.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1842.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1855.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 788.92, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2719.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 788.92, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 788.92, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2491.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2491.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2491.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2525.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1971.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3337.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 5086.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 2889.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2807.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2566.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2889.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2566.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2209.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3337.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 5086.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2807.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2549.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 788.92, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2491.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 2525.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2525.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 2549.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2525.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2761.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1855.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1757.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1679.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3337.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 5086.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 2889.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 2889.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1869.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2807.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 788.92, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 788.92, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1821.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1855.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 2515.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 2362.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 2209.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 788.92, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2491.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2566.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2209.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1648.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1480.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 788.92, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2549.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1855.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2549.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2719.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2549.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2719.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2761.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 788.92, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 788.92, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1842.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1842.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2549.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2209.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2549.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2549.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "IMMUNE GLOBULIN, HUMAN (GAMMAGARD S-D) 10 G/200 ML (5% RECONSTITUTION)", "code_information": [{"code": "J1566", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1577.84, "maximum": 10172.08, "gross_charge": 6797.6, "discounted_cash": 4078.56, "payers_information": [{"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5098.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 5098.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4418.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3684.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3684.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1577.84, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1577.84, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5098.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5438.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5523.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5098.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5438.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3711.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5098.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1577.84, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2960.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5132.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4418.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3296.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4982.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1577.84, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 5030.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4724.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 4418.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3711.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3643.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1577.84, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1577.84, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6674.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 10172.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 5777.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5777.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3738.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5614.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3711.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3514.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3358.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5050.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5523.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4982.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 5050.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5050.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 5098.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1577.84, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 5098.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6674.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 10172.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5614.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5132.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4418.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5777.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5132.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6674.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 10172.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5777.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5614.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4982.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5050.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3942.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4982.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4982.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1577.84, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1577.84, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5438.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1577.84, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3711.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3684.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5098.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1577.84, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3942.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1577.84, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5098.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5050.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5098.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "IMMUNE GLOBULIN, HUMAN (GAMMAGARD) (10%) SOLUTION", "code_information": [{"code": "J1569", "type": "HCPCS"}], "drug_information": {"unit": 100, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 945.76, "maximum": 6097.57, "gross_charge": 4676.7, "discounted_cash": 2806.02, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3428.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 3474.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3474.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 3507.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3474.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3231.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2553.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2417.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2310.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3507.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3530.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3975.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3530.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3039.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4000.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 6097.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3862.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3507.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 945.76, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 945.76, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3507.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2534.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2553.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 945.76, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3741.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 945.76, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 945.76, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3474.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3507.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 945.76, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2712.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3507.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2506.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4000.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 6097.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 3975.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 3975.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2572.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3862.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 945.76, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 945.76, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2553.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 3039.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 2782.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 2572.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 945.76, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3428.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2237.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3530.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3039.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2268.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 945.76, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3507.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2553.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3507.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3741.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 945.76, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2852.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3741.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3231.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 945.76, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2534.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2534.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3507.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3039.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3428.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3428.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3428.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3474.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2712.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4000.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 6097.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 3975.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3862.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "GANCICLOVIR SODIUM 500 MG INTRAVENOUS SOLUTION", "code_information": [{"code": "J1570", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 123.09, "maximum": 216.1, "gross_charge": 253.8, "discounted_cash": 152.28, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 186.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 188.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 188.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 190.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 188.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 133.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 141.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 216.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 215.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 215.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 139.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 209.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 138.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 131.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 125.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 138.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 164.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 151.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 139.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 186.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 126.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 191.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 164.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 123.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 190.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 138.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 190.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 203.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 154.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 203.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 133.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 137.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 137.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 190.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 164.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 186.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 186.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 186.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 188.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 147.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 141.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 216.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 215.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 209.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 203.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 190.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 191.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 191.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 164.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 141.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 216.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 209.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 215.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 190.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 190.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 137.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 138.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 188.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 190.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 147.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 190.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "GANCICLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION", "code_information": [{"code": "J1570", "type": "HCPCS"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 91.71, "maximum": 216.1, "gross_charge": 189.1, "discounted_cash": 113.46, "payers_information": [{"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 141.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 216.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 160.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 156.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 138.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 140.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 109.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 138.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 138.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 141.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 122.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 115.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 151.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 133.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 141.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 151.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 141.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 142.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 122.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 138.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 122.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 140.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 133.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 138.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 140.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 140.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 141.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 97.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 141.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 216.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 160.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 160.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 156.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 141.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 141.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 160.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 141.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 216.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 156.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 142.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 122.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 142.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 141.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 151.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 141.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 109.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 141.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 140.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "GANCICLOVIR IV SYRINGE 5 MG/ML (PEDIATRICS)", "code_information": [{"code": "J1570", "type": "HCPCS"}], "drug_information": {"unit": 500, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 632.97, "maximum": 1109.34, "gross_charge": 1305.1, "discounted_cash": 783.06, "payers_information": [{"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 712.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 978.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 985.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 848.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 632.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 848.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 776.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 717.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 956.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 652.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 708.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1080.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1109.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 1109.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 717.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1078.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 712.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 674.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 644.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 699.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 712.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 956.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 969.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 969.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 978.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 969.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 669.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 978.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1044.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 796.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1044.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 669.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 707.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 707.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 978.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 848.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 956.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 956.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 956.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 969.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 756.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 708.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1080.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 1109.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1078.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 978.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 712.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 969.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 978.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 756.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 978.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 707.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1044.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 978.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 985.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 985.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 848.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 708.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1080.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1078.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1109.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 978.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "GANCICLOVIR IVPB 5 MG/ML (PEDIATRICS)", "code_information": [{"code": "J1570", "type": "HCPCS"}], "drug_information": {"unit": 100, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 133.92, "maximum": 243.14, "gross_charge": 286.05, "discounted_cash": 171.63, "payers_information": [{"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 214.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 214.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 243.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 141.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 216.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 236.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 215.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 185.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 215.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 214.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 228.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 155.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 214.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 165.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 214.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 212.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 156.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 141.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 216.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 243.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 236.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 209.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 212.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 165.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 209.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 209.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 214.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 185.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 155.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 155.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 174.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 228.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 133.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 214.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 228.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 156.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 212.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 133.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 209.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 212.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 212.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 214.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 156.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 153.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 156.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 147.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 141.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 141.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 216.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 243.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 243.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 157.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 236.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 143.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 209.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 185.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 170.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 157.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 215.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 185.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 138.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 214.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "GENTAMICIN 100 MG/50 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK", "code_information": [{"code": "J1580", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 9.94, "maximum": 27.98, "gross_charge": 20.5, "discounted_cash": 12.3, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 17.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 17.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 18.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 27.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 18.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 27.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 18.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 27.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "GENTAMICIN 100 MG/50 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "J1580", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 4.97, "maximum": 13.99, "gross_charge": 10.25, "discounted_cash": 6.15, "payers_information": [{"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 9.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 13.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 9.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 13.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 9.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 13.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "GENTAMICIN SULFATE (PEDIATRIC) (PF) 20 MG/2 ML INJECTION SOLUTION", "code_information": [{"code": "J1580", "type": "HCPCS"}], "drug_information": {"unit": 2, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 6.01, "maximum": 13.99, "gross_charge": 12.4, "discounted_cash": 7.44, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 9.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 13.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 9.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 13.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 9.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 13.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "GENTAMICIN 40 MG/ML INJECTION SOLUTION", "code_information": [{"code": "J1580", "type": "HCPCS"}], "drug_information": {"unit": 20, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 66.42, "maximum": 139.9, "gross_charge": 136.95, "discounted_cash": 82.17, "payers_information": [{"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 91.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 139.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 116.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 116.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 113.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 88.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 109.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 95.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 109.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 91.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 139.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 116.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 113.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 109.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 88.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 91.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 139.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 113.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 116.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "GENTAMICIN IV SYRINGE 2 MG/ML (PEDIATRICS)", "code_information": [{"code": "J1580", "type": "HCPCS"}], "drug_information": {"unit": 480, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.53, "maximum": 167.88, "gross_charge": 3.15, "discounted_cash": 1.89, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 106.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 110.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 167.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 110.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 167.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 106.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 110.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 167.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "GENTAMICIN IV SYRINGE 2 MG/ML (PEDIATRICS)", "code_information": [{"code": "J1580", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.53, "maximum": 167.88, "gross_charge": 20.5, "discounted_cash": 12.3, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 17.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 18.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 27.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 18.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 27.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 17.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 18.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 27.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "GENTAMICIN IV SYRINGE 2 MG/ML (PEDIATRICS)|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "J1580", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 4.97, "maximum": 13.99, "gross_charge": 10.25, "discounted_cash": 6.15, "payers_information": [{"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 9.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 13.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 9.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 13.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 9.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 13.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "GENTAMICIN (PF) 2 MG/ML INTRA-CATHETER SOLUTION", "code_information": [{"code": "J1580", "type": "HCPCS"}], "drug_information": {"unit": 2, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 4.97, "maximum": 13.99, "gross_charge": 10.25, "discounted_cash": 6.15, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 9.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 13.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 9.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 13.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 9.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 13.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION (SO)", "code_information": [{"code": "J1596", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.79, "maximum": 31.24, "gross_charge": 3.7, "discounted_cash": 2.22, "payers_information": [{"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION (SO)", "code_information": [{"code": "J1596", "type": "HCPCS"}], "drug_information": {"unit": 2, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.79, "maximum": 31.24, "gross_charge": 36.75, "discounted_cash": 22.05, "payers_information": [{"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 9.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 9.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 9.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION (SO)", "code_information": [{"code": "J1596", "type": "HCPCS"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.79, "maximum": 31.24, "gross_charge": 12.15, "discounted_cash": 7.29, "payers_information": [{"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 14.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 24.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 14.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 24.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 24.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION (SO) (PEDIATRICS)", "code_information": [{"code": "J1596", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.19, "maximum": 18.06, "gross_charge": 2.45, "discounted_cash": 1.47, "payers_information": [{"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "GOLIMUMAB 12.5 MG/ML INTRAVENOUS SOLUTION", "code_information": [{"code": "J1602", "type": "HCPCS"}], "drug_information": {"unit": 4, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 581.55, "maximum": 7785.36, "gross_charge": 9159.25, "discounted_cash": 5495.55, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6713.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 6805.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 6805.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 6869.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 6805.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1864.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5000.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4735.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4524.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4909.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2459.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 3748.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 7785.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 7785.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5037.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7565.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 581.55, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 581.55, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5000.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 5953.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 5037.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 5037.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 581.55, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6713.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2638.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6915.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5953.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4442.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 581.55, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6869.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5000.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6869.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7327.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 581.55, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7327.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1864.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 581.55, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4964.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4964.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 6869.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5953.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6713.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6713.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6713.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 6805.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 5312.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2459.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 3748.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 7785.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7565.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6869.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6915.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7785.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6915.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5953.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2459.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 3748.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7565.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 6869.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 581.55, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 581.55, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6869.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4964.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5000.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 581.55, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7327.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 581.55, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 581.55, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 6805.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6869.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 581.55, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 5312.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6869.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "GLUCAGON (HUMAN RECOMBINANT) 1 MG INJECTION (SO)", "code_information": [{"code": "J1611", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 143.25, "maximum": 923.53, "gross_charge": 535.85, "discounted_cash": 321.51, "payers_information": [{"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 143.25, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 392.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 267.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 404.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 348.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 259.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 143.25, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 401.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 292.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 401.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 428.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 143.25, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 428.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 489.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 143.25, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 290.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 290.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 401.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 348.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 392.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 392.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 392.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 398.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 310.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 605.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 923.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 455.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 442.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 401.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 404.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 455.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 404.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 348.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 605.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 923.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 442.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 401.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 143.25, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 143.25, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 401.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 290.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 292.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 143.25, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 428.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 143.25, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 143.25, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 398.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 401.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 143.25, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 310.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 401.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 392.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 398.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 398.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 401.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 398.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 489.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 292.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 277.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 264.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 287.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 605.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 923.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 455.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 455.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 294.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 442.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 143.25, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 143.25, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 292.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 348.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 294.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 294.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "GLUCAGON (HUMAN RECOMBINANT) 1 MG INJECTION (SO)|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "J1611", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 348.3, "maximum": 401.89, "gross_charge": 535.85, "discounted_cash": 321.51, "payers_information": [{"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 396.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 372.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 348.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 401.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION", "code_information": [{"code": "J1630", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 2.21, "maximum": 4.71, "gross_charge": 4.55, "discounted_cash": 2.73, "payers_information": [{"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HALOPERIDOL LACTATE 5 MG/ML INTRAVENOUS SOLUTION (PEDIATRICS)", "code_information": [{"code": "J1630", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 2.21, "maximum": 4.71, "gross_charge": 4.55, "discounted_cash": 2.73, "payers_information": [{"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HEPARIN, PORCINE (PF) 10 UNIT/ML INTRAVENOUS SYRINGE", "code_information": [{"code": "J1642", "type": "HCPCS"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.35, "maximum": 2.13, "gross_charge": 2.5, "discounted_cash": 1.5, "payers_information": [{"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HEPARIN, PORCINE (PF) 100 UNIT/ML INTRAVENOUS SYRINGE", "code_information": [{"code": "J1642", "type": "HCPCS"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.55, "maximum": 6.45, "gross_charge": 3.2, "discounted_cash": 1.92, "payers_information": [{"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HEPARIN LOCK FLUSH (PORCINE) 10 UNIT/ML IV ORDERABLE", "code_information": [{"code": "J1642", "type": "HCPCS"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.07, "maximum": 2.13, "gross_charge": 2.5, "discounted_cash": 1.5, "payers_information": [{"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HEPARIN (PORCINE) 100 UNIT/ML INJECTION SYRINGE", "code_information": [{"code": "J1642", "type": "HCPCS"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.89, "maximum": 12.89, "gross_charge": 3.9, "discounted_cash": 2.34, "payers_information": [{"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 12.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 12.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 12.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HEPARIN 100 UNIT/ML INTRAVENOUS BOLUS SYRINGE (PEDIATRIC)", "code_information": [{"code": "J1642", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 9.09, "maximum": 64.47, "gross_charge": 18.75, "discounted_cash": 11.25, "payers_information": [{"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 42.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 64.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 42.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 64.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 42.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 64.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 35.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 35.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION", "code_information": [{"code": "J1644", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.74, "maximum": 11.82, "gross_charge": 10.35, "discounted_cash": 6.21, "payers_information": [{"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION", "code_information": [{"code": "J1644", "type": "HCPCS"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.74, "maximum": 11.82, "gross_charge": 13.9, "discounted_cash": 8.34, "payers_information": [{"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 11.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 11.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 11.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION", "code_information": [{"code": "J1644", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 2.62, "maximum": 5.8, "gross_charge": 5.4, "discounted_cash": 3.24, "payers_information": [{"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HEPARIN, PORCINE (PF) 1,000 UNIT/ML INJECTION SOLUTION", "code_information": [{"code": "J1644", "type": "HCPCS"}], "drug_information": {"unit": 2, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.48, "maximum": 25.76, "gross_charge": 30.3, "discounted_cash": 18.18, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HEPARIN (PORCINE) (PF) 1,000 UNIT/500 ML IN 0.9 % SODIUM CHLORIDE IV", "code_information": [{"code": "J1644", "type": "HCPCS"}], "drug_information": {"unit": 500, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.74, "maximum": 15.94, "gross_charge": 18.75, "discounted_cash": 11.25, "payers_information": [{"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HEPARIN (PORCINE) 25,000 UNIT/250 ML (100 UNIT/ML) IN DEXTROSE 5 % IV", "code_information": [{"code": "J1644", "type": "HCPCS"}], "drug_information": {"unit": 250, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 18.5, "maximum": 73.31, "gross_charge": 86.25, "discounted_cash": 51.75, "payers_information": [{"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 19.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 29.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 18.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 18.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 19.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 29.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 19.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 29.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HEPARIN IV INFUSION 100 UNITS/ML (PEDIATRICS)", "code_information": [{"code": "J1644", "type": "HCPCS"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.74, "maximum": 73.31, "gross_charge": 3.9, "discounted_cash": 2.34, "payers_information": [{"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HEPARIN IV INFUSION 100 UNITS/ML (PEDIATRICS)", "code_information": [{"code": "J1644", "type": "HCPCS"}], "drug_information": {"unit": 20, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.74, "maximum": 73.31, "gross_charge": 7.8, "discounted_cash": 4.68, "payers_information": [{"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HEPARIN IV INFUSION 100 UNITS/ML (PEDIATRICS)", "code_information": [{"code": "J1644", "type": "HCPCS"}], "drug_information": {"unit": 250, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.74, "maximum": 73.31, "gross_charge": 86.25, "discounted_cash": 51.75, "payers_information": [{"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 19.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 29.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 18.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 19.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 29.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 19.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 29.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 18.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HEPARIN IV INFUSION 100 UNITS/ML (PEDIATRICS)", "code_information": [{"code": "J1644", "type": "HCPCS"}], "drug_information": {"unit": 30, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.74, "maximum": 73.31, "gross_charge": 11.7, "discounted_cash": 7.02, "payers_information": [{"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HEPARIN IV INFUSION 100 UNITS/ML (PEDIATRICS)", "code_information": [{"code": "J1644", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.74, "maximum": 73.31, "gross_charge": 19.5, "discounted_cash": 11.7, "payers_information": [{"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HEPARIN 30,000 UNITS IN SODIUM CHLORIDE 0.9% 1000 ML", "code_information": [{"code": "J1644", "type": "HCPCS"}], "drug_information": {"unit": 1000, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 9.8, "maximum": 34.81, "gross_charge": 20.2, "discounted_cash": 12.12, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 22.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 22.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 34.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 22.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 34.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 22.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 22.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 34.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SYRINGE", "code_information": [{"code": "J1644", "type": "HCPCS"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 7.01, "maximum": 24.57, "gross_charge": 14.45, "discounted_cash": 8.67, "payers_information": [{"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 11.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 11.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 11.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SYRINGE", "code_information": [{"code": "J1644", "type": "HCPCS"}], "drug_information": {"unit": 20, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 7.01, "maximum": 24.57, "gross_charge": 28.9, "discounted_cash": 17.34, "payers_information": [{"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 15.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 23.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 14.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 15.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 23.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 15.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 23.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 14.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION (USE WITH TPN CALCULATOR)", "code_information": [{"code": "J1644", "type": "HCPCS"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 5.5, "maximum": 11.6, "gross_charge": 11.35, "discounted_cash": 6.81, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 11.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 11.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 11.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HEPARIN 100,000 UNITS IN SODIUM CHLORIDE 0.9% 1000 ML SIMPLE", "code_information": [{"code": "J1644", "type": "HCPCS"}], "drug_information": {"unit": 1000, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 46.56, "maximum": 116.05, "gross_charge": 96.0, "discounted_cash": 57.6, "payers_information": [{"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 76.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 116.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 74.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 76.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 116.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 76.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 116.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 74.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HEPARIN (PORCINE) (PF) IV SYRINGE 2 UNIT/ML", "code_information": [{"code": "J1644", "type": "HCPCS"}], "drug_information": {"unit": 500, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 9.09, "maximum": 15.94, "gross_charge": 18.75, "discounted_cash": 11.25, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HEPARIN, PORCINE (PF) 100 UNIT/ML IV (FOR FLUID ADDITIVE)", "code_information": [{"code": "J1644", "type": "HCPCS"}], "drug_information": {"unit": 250, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 18.5, "maximum": 73.31, "gross_charge": 86.25, "discounted_cash": 51.75, "payers_information": [{"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 19.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 29.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 18.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 19.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 29.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 19.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 29.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 18.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HEPARIN IV INFUSION 100 UNITS/ML (PED AQUAPHERESIS)", "code_information": [{"code": "J1644", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.7, "maximum": 16.58, "gross_charge": 19.5, "discounted_cash": 11.7, "payers_information": [{"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HEPARIN IV INFUSION 1,000 UNITS/ML (PEDIATRICS)", "code_information": [{"code": "J1644", "type": "HCPCS"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 7.4, "maximum": 85.09, "gross_charge": 20.05, "discounted_cash": 12.03, "payers_information": [{"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 11.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 11.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 11.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HEPARIN IV INFUSION 1,000 UNITS/ML (PEDIATRICS)", "code_information": [{"code": "J1644", "type": "HCPCS"}], "drug_information": {"unit": 20, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 7.4, "maximum": 85.09, "gross_charge": 40.05, "discounted_cash": 24.03, "payers_information": [{"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 14.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 15.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 23.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 15.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 23.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 15.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 23.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 14.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HEPARIN IV INFUSION 1,000 UNITS/ML (PEDIATRICS)", "code_information": [{"code": "J1644", "type": "HCPCS"}], "drug_information": {"unit": 30, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 7.4, "maximum": 85.09, "gross_charge": 60.1, "discounted_cash": 36.06, "payers_information": [{"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 22.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 22.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 34.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 22.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 34.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 22.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 34.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 22.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HEPARIN IV INFUSION 1,000 UNITS/ML (PEDIATRICS)", "code_information": [{"code": "J1644", "type": "HCPCS"}], "drug_information": {"unit": 40, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 7.4, "maximum": 85.09, "gross_charge": 80.1, "discounted_cash": 48.06, "payers_information": [{"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 29.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 30.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 46.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 30.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 46.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 30.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 46.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 29.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HEPARIN IV INFUSION 1,000 UNITS/ML (PEDIATRICS)", "code_information": [{"code": "J1644", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 7.4, "maximum": 85.09, "gross_charge": 100.1, "discounted_cash": 60.06, "payers_information": [{"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 37.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 38.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 58.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 38.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 58.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 38.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 58.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 37.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DEXTROSE 5% AND 0.2% SODIUM CHLORIDE WITH HEPARIN 1,000 UNITS/L 50 ML (PREMIX)", "code_information": [{"code": "J1644", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.1, "maximum": 0.17, "gross_charge": 0.2, "discounted_cash": 0.12, "payers_information": [{"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HEPARIN 100 UNIT/ML INTRAVENOUS BOLUS SYRINGE (PEDIATRIC)", "code_information": [{"code": "J1644", "type": "HCPCS"}], "drug_information": {"unit": 250, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 9.09, "maximum": 64.47, "gross_charge": 48.45, "discounted_cash": 29.07, "payers_information": [{"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 18.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 19.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 29.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 19.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 29.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 18.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 19.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 29.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ENOXAPARIN 300 MG/3 ML INJECTION SOLUTION", "code_information": [{"code": "J1650", "type": "HCPCS"}], "drug_information": {"unit": 3, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 57.9, "maximum": 130.56, "gross_charge": 153.6, "discounted_cash": 92.16, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 115.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 67.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 102.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 130.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 126.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 115.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 115.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 115.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 67.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 102.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 126.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 130.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 115.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 115.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 122.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 115.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 67.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 102.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 130.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 130.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 126.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 57.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 113.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 115.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 115.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 115.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 122.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 57.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 115.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 122.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 115.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 115.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ENOXAPARIN SYRINGE 20 MG/ML (PEDIATRICS)", "code_information": [{"code": "J1650", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 193.0, "maximum": 457.43, "gross_charge": 538.15, "discounted_cash": 322.89, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 394.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 399.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 399.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 403.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 403.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 312.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 224.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 341.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 457.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 444.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 394.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 399.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 312.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 394.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 394.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 403.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 399.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 430.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 293.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 291.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 403.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 403.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 457.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 224.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 341.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 444.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 406.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 349.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 406.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 403.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 403.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 349.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 291.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 291.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 403.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 430.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 403.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 430.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 193.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 293.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 403.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 269.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 394.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 406.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 349.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 261.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 398.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 374.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 349.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 293.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 288.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 399.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 193.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 293.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 278.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 265.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 224.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 341.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 457.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 457.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 295.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 444.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ENOXAPARIN SYRINGE 20 MG/ML (PEDIATRICS)|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "J1650", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 295.98, "maximum": 349.8, "gross_charge": 538.15, "discounted_cash": 322.89, "payers_information": [{"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 349.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 320.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 295.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 328.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ENOXAPARIN SYRINGE 100 MG/ML (PEDIATRICS)", "code_information": [{"code": "J1650", "type": "HCPCS"}], "drug_information": {"unit": 3, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 57.9, "maximum": 144.37, "gross_charge": 169.85, "discounted_cash": 101.91, "payers_information": [{"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 128.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 128.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 110.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 67.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 102.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 140.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 144.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 135.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 126.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 124.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 124.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 124.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 126.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 67.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 102.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 144.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 140.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 110.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 135.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 57.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 124.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 125.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 118.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 110.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 128.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 110.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 67.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 102.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 144.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 144.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 140.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 126.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 57.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 135.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 124.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 126.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 126.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TETANUS IMMUNE GLOBULIN (PF) 250 UNIT/ML INTRAMUSCULAR SYRINGE", "code_information": [{"code": "J1670", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 588.54, "maximum": 1950.43, "gross_charge": 2240.3, "discounted_cash": 1344.18, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1950.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 588.54, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 588.54, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 588.54, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 588.54, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 588.54, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1792.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1950.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 588.54, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1299.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 588.54, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 588.54, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 588.54, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 588.54, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 588.54, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 588.54, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1299.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HYDROCORTISONE SODIUM SUCCINATE 100 MG SOLUTION FOR INJECTION", "code_information": [{"code": "J1720", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 50.32, "maximum": 142.22, "gross_charge": 103.75, "discounted_cash": 62.25, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 71.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 93.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 142.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 88.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 88.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 71.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 93.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 142.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 88.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 88.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 93.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 142.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HYDROCORTISONE SOD SUCCINATE (PF) 100 MG/2 ML SOLUTION FOR INJECTION", "code_information": [{"code": "J1720", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 60.79, "maximum": 142.22, "gross_charge": 125.35, "discounted_cash": 75.21, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 93.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 142.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 71.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 71.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 93.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 142.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 93.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 142.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HYDROCORTISONE IV SYRINGE 50 MG/ML (PEDIATRICS)", "code_information": [{"code": "J1720", "type": "HCPCS"}], "drug_information": {"unit": 2, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 54.51, "maximum": 142.22, "gross_charge": 112.4, "discounted_cash": 67.44, "payers_information": [{"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 93.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 142.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 95.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 71.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 95.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 93.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 142.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 71.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 93.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 142.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 95.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 95.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HYDROCORTISONE IV SYRINGE 1 MG/ML (PEDIATRICS)", "code_information": [{"code": "J1720", "type": "HCPCS"}], "drug_information": {"unit": 100, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 63.44, "maximum": 142.22, "gross_charge": 130.8, "discounted_cash": 78.48, "payers_information": [{"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 95.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 93.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 142.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 111.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 111.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 71.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 97.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 95.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 97.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 97.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 97.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 93.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 142.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 111.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 95.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 97.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 71.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 95.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 95.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 93.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 142.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 111.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HYDROCORTISONE SOD SUCCINATE (PF) 100 MG/2 ML SOLUTION FOR INJECTION (PEDIATRICS)", "code_information": [{"code": "J1720", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 60.79, "maximum": 142.22, "gross_charge": 125.35, "discounted_cash": 75.21, "payers_information": [{"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 93.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 142.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 93.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 142.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 71.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 71.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 93.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 142.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HYDROCORTISONE SODIUM SUCCINATE 100 MG SOLUTION FOR INJECTION (PEDIATRICS)", "code_information": [{"code": "J1720", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 50.32, "maximum": 142.22, "gross_charge": 103.75, "discounted_cash": 62.25, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 93.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 142.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 88.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 88.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 71.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 93.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 142.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 88.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 71.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 93.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 142.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 88.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "IDURSULFASE 6 MG/3 ML INTRAVENOUS SOLUTION", "code_information": [{"code": "J1743", "type": "HCPCS"}], "drug_information": {"unit": 3, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 3348.61, "maximum": 11482.32, "gross_charge": 14352.9, "discounted_cash": 8611.74, "payers_information": [{"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3348.61, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "fee schedule", "standard_charge_dollar": 4111.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11482.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3348.61, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11482.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11327.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3348.61, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7779.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 10764.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10520.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10520.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10520.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 8324.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 10764.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3348.61, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3348.61, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7779.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "fee schedule", "standard_charge_dollar": 4111.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3348.61, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11482.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3348.61, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3348.61, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3348.61, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 8324.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10520.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11327.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "fee schedule", "standard_charge_dollar": 4111.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "fee schedule", "standard_charge_dollar": 4111.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "fee schedule", "standard_charge_dollar": 4111.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7693.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7894.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3348.61, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3348.61, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "fee schedule", "standard_charge_dollar": 4111.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 7894.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3348.61, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10520.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4139.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "INFLIXIMAB 100 MG INTRAVENOUS SOLUTION", "code_information": [{"code": "J1745", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 324.23, "maximum": 4547.84, "gross_charge": 5350.4, "discounted_cash": 3210.24, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3921.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 3975.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3975.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 4012.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3975.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1053.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2921.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2766.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2643.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2867.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1371.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 2090.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4547.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4547.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2942.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4419.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 324.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 324.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2921.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 3959.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 3718.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 3477.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 324.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3921.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 627.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4039.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3477.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2594.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 324.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4012.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2921.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4012.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4280.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 324.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4012.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4280.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1053.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 324.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2899.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2899.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 4012.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3477.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3921.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3921.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3921.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3975.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3103.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1371.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 2090.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4547.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4419.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4012.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4039.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4547.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4039.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3477.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1371.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 2090.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4419.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 4012.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 324.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 324.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4012.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2899.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2921.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 324.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4280.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 324.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 324.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3975.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4012.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 324.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3103.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4012.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "IRON DEXTRAN 50 MG/ML INJECTION SOLUTION", "code_information": [{"code": "J1750", "type": "HCPCS"}], "drug_information": {"unit": 2, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 36.16, "maximum": 233.12, "gross_charge": 187.45, "discounted_cash": 112.47, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 137.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 139.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 139.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 140.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 139.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 121.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 96.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 152.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 233.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 159.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 159.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 154.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 36.16, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 36.16, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 138.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 130.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 121.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 36.16, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 137.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 141.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 121.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 36.16, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 140.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 140.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 149.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 36.16, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 140.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 149.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 121.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 36.16, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 140.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 121.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 137.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 137.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 137.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 139.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 152.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 233.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 159.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 154.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 140.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 141.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 159.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 141.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 121.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 152.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 233.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 154.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 140.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 36.16, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 36.16, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 140.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 36.16, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 149.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 36.16, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 36.16, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 139.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 140.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 36.16, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 140.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "IRON SUCROSE 100 MG/5 ML (ELEMENTAL IRON) INTRAVENOUS SOLUTION", "code_information": [{"code": "J1756", "type": "HCPCS"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 74.0, "maximum": 154.73, "gross_charge": 160.9, "discounted_cash": 96.54, "payers_information": [{"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 117.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 117.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 117.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 119.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 101.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 154.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 132.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 121.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 121.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 101.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 154.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 132.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 128.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 119.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 117.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 119.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 119.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 119.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 74.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 101.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 154.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 88.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 132.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 88.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 88.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 117.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 121.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 128.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 128.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 74.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "IRON SUCROSE 100 MG/5 ML (ELEMENTAL IRON) INTRAVENOUS SOLUTION|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "J1756", "type": "HCPCS"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 120.68, "maximum": 120.68, "gross_charge": 160.9, "discounted_cash": 96.54, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "IMIGLUCERASE 400 UNIT INTRAVENOUS SOLUTION", "code_information": [{"code": "J1786", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1729.28, "maximum": 6029.44, "gross_charge": 7536.8, "discounted_cash": 4522.08, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5852.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "fee schedule", "standard_charge_dollar": 2119.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "fee schedule", "standard_charge_dollar": 2119.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "fee schedule", "standard_charge_dollar": 2119.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1729.28, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1729.28, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "fee schedule", "standard_charge_dollar": 2119.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1729.28, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2266.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1729.28, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "fee schedule", "standard_charge_dollar": 2119.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1729.28, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6029.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5852.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1729.28, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4371.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1729.28, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1729.28, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "fee schedule", "standard_charge_dollar": 2119.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1729.28, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1729.28, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1729.28, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1729.28, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4371.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DROPERIDOL 2.5 MG/ML INJECTION SOLUTION", "code_information": [{"code": "J1790", "type": "HCPCS"}], "drug_information": {"unit": 2, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 18.12, "maximum": 46.29, "gross_charge": 48.2, "discounted_cash": 28.92, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 18.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 30.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 46.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 18.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 30.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 46.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 30.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 46.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DROPERIDOL 2.5 MG/ML IV SOLUTION (PEDIATRICS)", "code_information": [{"code": "J1790", "type": "HCPCS"}], "drug_information": {"unit": 2, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 18.12, "maximum": 46.29, "gross_charge": 48.2, "discounted_cash": 28.92, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 30.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 46.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 18.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 30.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 46.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 18.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 30.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 46.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PROPRANOLOL 1 MG/ML INTRAVENOUS SOLUTION", "code_information": [{"code": "J1800", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 34.14, "maximum": 48.32, "gross_charge": 60.4, "discounted_cash": 36.24, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 34.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 34.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PROPRANOLOL IV SYRINGE 0.1 MG/ML (DILUTE) (PEDIATRICS)", "code_information": [{"code": "J1800", "type": "HCPCS"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 16.36, "maximum": 34.14, "gross_charge": 28.2, "discounted_cash": 16.92, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 34.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 34.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ESMOLOL 10 MG/ML IV SYRINGE (PEDIATRICS)", "code_information": [{"code": "J1805", "type": "HCPCS"}], "drug_information": {"unit": 250, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 127.97, "maximum": 338.47, "gross_charge": 263.85, "discounted_cash": 158.31, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 193.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 196.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 196.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 197.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 196.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 237.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 144.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 130.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 141.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 222.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 338.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 224.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 224.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 145.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 217.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 144.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 171.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 145.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 145.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 193.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 131.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 199.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 171.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 197.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 144.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 197.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 211.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 211.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 237.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 143.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 143.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 197.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 171.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 193.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 193.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 193.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 196.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 153.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 222.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 338.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 224.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 217.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 197.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 199.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 224.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 199.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 171.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 222.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 338.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 217.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 197.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 197.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 143.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 144.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 211.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 196.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 197.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 153.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 197.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ESMOLOL 2,500 MG/250 ML (10 MG/ML) IN SODIUM CHLORIDE (ISO-OSMOTIC) IV", "code_information": [{"code": "J1806", "type": "HCPCS"}], "drug_information": {"unit": 250, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 216.43, "maximum": 660.82, "gross_charge": 446.25, "discounted_cash": 267.75, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 331.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 355.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 327.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 331.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 331.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 334.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 433.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 660.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 379.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 379.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 245.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 368.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 243.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 230.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 220.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 239.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 243.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 330.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 310.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 290.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 327.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 223.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 336.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 290.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 216.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 334.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 243.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 334.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 357.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 334.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 357.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 355.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 241.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 241.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 334.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 290.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 327.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 327.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 433.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 660.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 379.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 368.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 327.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 331.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 258.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 334.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 336.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 336.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 290.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 433.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 660.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 368.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 379.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 334.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 334.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 241.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 334.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 258.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 243.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 357.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 331.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 334.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ESMOLOL INFUSION 10 MG/ML (PEDIATRICS)", "code_information": [{"code": "J1806", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.42, "maximum": 49.13, "gross_charge": 57.8, "discounted_cash": 34.68, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ETHACRYNIC ACID 50 MG INTRAVENOUS SOLUTION", "code_information": [{"code": "J1807", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 644.1, "maximum": 1629.48, "gross_charge": 2036.85, "discounted_cash": 1222.11, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1493.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1018.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1006.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1091.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1120.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 644.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 644.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1120.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 644.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1493.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1018.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 644.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1629.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 644.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1629.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1018.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 644.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1103.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1527.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1493.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1493.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1493.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1181.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1527.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 644.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 644.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1103.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 644.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1629.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 644.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 644.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 644.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1181.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FOLIC ACID 5 MG/ML INJECTION SOLUTION", "code_information": [{"code": "J1808", "type": "HCPCS"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 61.33, "maximum": 161.18, "gross_charge": 126.45, "discounted_cash": 75.87, "payers_information": [{"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 100.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 105.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 161.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 107.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 95.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 107.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 95.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 105.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 161.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 100.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 105.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 161.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 107.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 107.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 95.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION", "code_information": [{"code": "J1815", "type": "HCPCS"}], "drug_information": {"unit": 1000, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 52.54, "maximum": 85.08, "gross_charge": 106.35, "discounted_cash": 63.81, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS PEN", "code_information": [{"code": "J1815", "type": "HCPCS"}], "drug_information": {"unit": 3, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 50.59, "maximum": 81.92, "gross_charge": 102.4, "discounted_cash": 61.44, "payers_information": [{"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION", "code_information": [{"code": "J1815", "type": "HCPCS"}], "drug_information": {"unit": 1000, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 122.17, "maximum": 197.84, "gross_charge": 247.3, "discounted_cash": 148.38, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 176.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 122.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 184.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 195.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 197.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 176.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 197.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 134.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 185.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 195.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 195.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 143.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 195.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 195.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 185.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 134.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 197.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 143.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS HALF-UNIT PEN", "code_information": [{"code": "J1815", "type": "HCPCS"}], "drug_information": {"unit": 3, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 50.59, "maximum": 81.92, "gross_charge": 102.4, "discounted_cash": 61.44, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "INSULIN ASPART U-100  100 UNIT/ML SUBCUTANEOUS SOLUTION", "code_information": [{"code": "J1815", "type": "HCPCS"}], "drug_information": {"unit": 1000, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 94.87, "maximum": 153.64, "gross_charge": 192.05, "discounted_cash": 115.23, "payers_information": [{"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 144.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 153.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 111.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 143.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 151.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 153.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 153.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 144.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 151.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 151.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 111.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 151.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 151.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ISAVUCONAZONIUM SULFATE 372 MG INTRAVENOUS SOLUTION", "code_information": [{"code": "J1833", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 375.35, "maximum": 1268.52, "gross_charge": 1460.55, "discounted_cash": 876.33, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1070.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1268.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 721.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 782.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 803.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 375.35, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 375.35, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 803.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 375.35, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1070.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 730.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 375.35, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1168.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 375.35, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1168.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1268.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 375.35, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 791.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1095.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1070.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1070.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1070.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 847.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1095.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 375.35, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 375.35, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 791.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 375.35, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1168.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 375.35, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 375.35, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 375.35, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 847.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "METRONIDAZOLE IV SYRINGE (PEDIATRICS)", "code_information": [{"code": "J1836", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 2.5, "maximum": 4.84, "gross_charge": 5.2, "discounted_cash": 3.12, "payers_information": [{"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "METRONIDAZOLE IV SYRINGE (PEDIATRICS)|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "J1836", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 2.86, "maximum": 3.38, "gross_charge": 5.2, "discounted_cash": 3.12, "payers_information": [{"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "METRONIDAZOLE 500 MG/100 ML IN SODIUM CHLOR(ISO) INTRAVENOUS PIGGYBACK", "code_information": [{"code": "J1836", "type": "HCPCS"}], "drug_information": {"unit": 100, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 4.56, "maximum": 9.67, "gross_charge": 9.4, "discounted_cash": 5.64, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 9.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 9.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 9.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "METRONIDAZOLE 500 MG/100 ML IN SODIUM CHLOR(ISO) INTRAVENOUS PIGGYBACK|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "J1836", "type": "HCPCS"}], "drug_information": {"unit": 100, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 5.17, "maximum": 6.11, "gross_charge": 9.4, "discounted_cash": 5.64, "payers_information": [{"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "POSACONAZOLE 300 MG/16.7 ML INTRAVENOUS SOLUTION", "code_information": [{"code": "J1837", "type": "HCPCS"}], "drug_information": {"unit": 16, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 103.8, "maximum": 577.96, "gross_charge": 722.45, "discounted_cash": 433.47, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 529.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 361.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 356.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 387.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 397.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 103.8, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 103.8, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 397.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 103.8, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 529.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 361.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 103.8, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 577.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 103.8, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 577.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 361.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 103.8, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 391.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 541.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 529.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 529.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 529.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 419.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 541.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 103.8, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 103.8, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 391.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 103.8, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 577.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 103.8, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 103.8, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 103.8, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 419.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "KETOROLAC 15 MG/ML INJECTION SOLUTION", "code_information": [{"code": "J1885", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.33, "maximum": 3.27, "gross_charge": 3.85, "discounted_cash": 2.31, "payers_information": [{"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 0.33, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 0.33, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 0.33, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 0.33, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 0.33, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 0.33, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 0.33, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 0.33, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 0.33, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 0.33, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 0.33, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 0.33, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "KETOROLAC 30 MG/ML INJECTION SOLUTION (SO)", "code_information": [{"code": "J1885", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.67, "maximum": 4.26, "gross_charge": 2.0, "discounted_cash": 1.2, "payers_information": [{"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 0.67, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 0.67, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 0.67, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 0.67, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 0.67, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 0.67, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 0.67, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 0.67, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 0.67, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 0.67, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 0.67, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 0.67, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "KETOROLAC 30 MG/ML INJECTION SOLUTION (SO) (PEDIATRICS)", "code_information": [{"code": "J1885", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.67, "maximum": 4.26, "gross_charge": 2.0, "discounted_cash": 1.2, "payers_information": [{"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 0.67, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 0.67, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 0.67, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 0.67, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 0.67, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 0.67, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 0.67, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 0.67, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 0.67, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 0.67, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 0.67, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 0.67, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "KETOROLAC 15 MG/ML INJECTION SOLUTION (PEDIATRICS)", "code_information": [{"code": "J1885", "type": "HCPCS"}], "drug_information": {"unit": 2, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.67, "maximum": 6.55, "gross_charge": 7.7, "discounted_cash": 4.62, "payers_information": [{"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 0.67, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 0.67, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 0.67, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 0.67, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 0.67, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 0.67, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 0.67, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 0.67, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 0.67, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 0.67, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 0.67, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 0.67, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LABETALOL 5 MG/ML INTRAVENOUS SOLUTION", "code_information": [{"code": "J1920", "type": "HCPCS"}], "drug_information": {"unit": 20, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 5.82, "maximum": 45.13, "gross_charge": 12.0, "discounted_cash": 7.2, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 26.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 29.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 45.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 26.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 29.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 45.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 29.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 45.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LARONIDASE 2.9 MG/5 ML INTRAVENOUS SOLUTION", "code_information": [{"code": "J1931", "type": "HCPCS"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 1158.64, "maximum": 7469.17, "gross_charge": 2573.45, "discounted_cash": 1544.07, "payers_information": [{"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1158.64, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1886.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 1912.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1912.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 1930.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1912.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3908.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "fee schedule", "standard_charge_dollar": 1418.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "fee schedule", "standard_charge_dollar": 1418.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1418.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1379.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4900.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 7469.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 2187.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 2187.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1415.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2125.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1158.64, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1158.64, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "fee schedule", "standard_charge_dollar": 1418.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 1904.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1788.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 1672.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1158.64, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1886.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1413.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1942.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1672.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1248.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1930.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "fee schedule", "standard_charge_dollar": 1418.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1930.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2058.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1158.64, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1930.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2058.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3908.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1158.64, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1394.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1394.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1930.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1672.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1886.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1886.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1886.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1912.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1492.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4900.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 7469.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 2187.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2125.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1930.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1942.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2187.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1942.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1672.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4900.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 7469.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2125.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1930.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1158.64, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1158.64, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1930.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1394.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "fee schedule", "standard_charge_dollar": 1418.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1158.64, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2058.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1158.64, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1158.64, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1912.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1930.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1158.64, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1492.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1930.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FUROSEMIDE 10 MG/ML INJECTION SOLUTION", "code_information": [{"code": "J1938", "type": "HCPCS"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.4, "maximum": 27.63, "gross_charge": 32.5, "discounted_cash": 19.5, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 12.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 12.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 12.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FUROSEMIDE 10 MG/ML INJECTION SOLUTION", "code_information": [{"code": "J1938", "type": "HCPCS"}], "drug_information": {"unit": 2, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.4, "maximum": 27.63, "gross_charge": 11.95, "discounted_cash": 7.17, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FUROSEMIDE 10 MG/ML INJECTION SOLUTION|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "J1938", "type": "HCPCS"}], "drug_information": {"unit": 2, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 6.57, "maximum": 21.13, "gross_charge": 11.95, "discounted_cash": 7.17, "payers_information": [{"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FUROSEMIDE 10 MG/ML INJECTION SOLUTION|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "J1938", "type": "HCPCS"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 6.57, "maximum": 21.13, "gross_charge": 32.5, "discounted_cash": 19.5, "payers_information": [{"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FUROSEMIDE INFUSION 10 MG/ML (PEDIATRICS)", "code_information": [{"code": "J1938", "type": "HCPCS"}], "drug_information": {"unit": 20, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.09, "maximum": 25.79, "gross_charge": 2.25, "discounted_cash": 1.35, "payers_information": [{"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 16.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 25.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 14.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 16.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 25.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 16.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 25.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 14.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FUROSEMIDE INFUSION 10 MG/ML (PEDIATRICS)|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "J1938", "type": "HCPCS"}], "drug_information": {"unit": 20, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.24, "maximum": 1.46, "gross_charge": 2.25, "discounted_cash": 1.35, "payers_information": [{"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FUROSEMIDE IV SYRINGE 10 MG/ML (PEDIATRICS)", "code_information": [{"code": "J1938", "type": "HCPCS"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.4, "maximum": 28.73, "gross_charge": 33.8, "discounted_cash": 20.28, "payers_information": [{"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 12.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 12.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 12.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FUROSEMIDE IV SYRINGE 10 MG/ML (PEDIATRICS)", "code_information": [{"code": "J1938", "type": "HCPCS"}], "drug_information": {"unit": 2, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.4, "maximum": 28.73, "gross_charge": 24.25, "discounted_cash": 14.55, "payers_information": [{"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "BUMETANIDE 0.25 MG/ML IV SOLUTION (PEDIATRICS)", "code_information": [{"code": "J1939", "type": "HCPCS"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 5.8, "maximum": 11.6, "gross_charge": 11.95, "discounted_cash": 7.17, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 10.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 11.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 10.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 11.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 11.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "BUMETANIDE 0.25 MG/ML INJECTION SOLUTION", "code_information": [{"code": "J1939", "type": "HCPCS"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 5.8, "maximum": 11.6, "gross_charge": 11.95, "discounted_cash": 7.17, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 11.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 11.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 10.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 11.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 10.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LEUPROLIDE 11.25 MG INTRAMUSCULAR KIT", "code_information": [{"code": "J1950", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 5291.61, "maximum": 34115.01, "gross_charge": 18031.05, "discounted_cash": 10818.63, "payers_information": [{"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9664.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9844.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9322.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8907.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 13397.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 17614.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 22383.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 34115.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 15326.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 15326.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 9917.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14893.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5291.61, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5291.61, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 13342.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 12531.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 11720.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9844.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5291.61, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13216.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6792.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13613.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11720.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8745.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5291.61, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13523.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13216.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 13397.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 13397.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 13523.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13523.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14424.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 17614.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13523.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14424.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9844.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5291.61, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5291.61, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9772.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9772.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 13523.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11720.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13216.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13216.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13216.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 13397.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 10458.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 22383.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 34115.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 15326.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14893.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13523.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13613.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13613.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11720.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 22383.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 34115.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14893.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15326.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 13523.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5291.61, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5291.61, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13523.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9772.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5291.61, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9844.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5291.61, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14424.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5291.61, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 13397.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13523.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5291.61, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 10458.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13523.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LEUPROLIDE 15 MG INTRAMUSCULAR KIT", "code_information": [{"code": "J1950", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 7055.48, "maximum": 45486.68, "gross_charge": 19859.4, "discounted_cash": 11915.64, "payers_information": [{"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14894.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 11518.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 7055.48, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14894.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 14755.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 7055.48, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15887.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 7055.48, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10843.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 7055.48, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10763.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14894.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 7055.48, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 7055.48, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 14894.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16880.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 29844.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 45486.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16403.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14993.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12908.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14993.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14894.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 29844.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 45486.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 16880.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16403.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14556.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 14755.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 11518.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14556.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14556.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 14894.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12908.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10763.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10763.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 7055.48, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 7055.48, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10843.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14894.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15887.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14894.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15887.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 23485.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14556.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 14755.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 14755.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 14894.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14894.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 7055.48, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14993.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12908.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9631.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 9057.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14556.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 7055.48, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10843.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 14695.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 13802.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 12908.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 7055.48, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 7055.48, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 29844.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 45486.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 16880.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 16880.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10922.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16403.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 14755.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 23485.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10843.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10267.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9810.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10644.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LEUPROLIDE 3.75 MG INTRAMUSCULAR SYRINGE KIT", "code_information": [{"code": "J1950", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1763.87, "maximum": 11371.67, "gross_charge": 8255.9, "discounted_cash": 4953.54, "payers_information": [{"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 6134.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6191.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1763.87, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4788.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6191.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1763.87, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6191.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6604.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5871.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6191.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6604.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4507.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1763.87, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1763.87, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4474.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4474.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 6191.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5366.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6051.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6051.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6051.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 6134.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4788.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7461.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 11371.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 7017.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6819.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6191.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6233.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6233.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5366.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7461.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 11371.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6819.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7017.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 6191.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1763.87, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1763.87, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6191.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4474.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1763.87, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4507.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1763.87, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6604.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 6134.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5871.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7461.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 11371.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 7017.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 7017.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4540.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6819.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4425.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4507.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4268.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4078.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1763.87, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1763.87, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 6109.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 5737.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 5366.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4507.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1763.87, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6051.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2264.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6233.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5366.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4004.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1763.87, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6191.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6051.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 6134.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 6134.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 6191.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LEUPROLIDE ACETATE 11.25 MG (3 MONTH) INTRAMUSCULAR SYRINGE KIT", "code_information": [{"code": "J1950", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 5291.61, "maximum": 34115.01, "gross_charge": 24767.75, "discounted_cash": 14860.65, "payers_information": [{"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18575.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 14365.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5291.61, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18575.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 18402.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5291.61, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5291.61, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19814.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5291.61, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13523.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13424.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18575.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5291.61, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5291.61, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 18575.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21052.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 22383.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 34115.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20458.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18699.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16099.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18699.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18575.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 22383.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 34115.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 21052.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20458.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18154.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 18402.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 14365.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18154.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18154.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 18575.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16099.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13424.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13424.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5291.61, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5291.61, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13523.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18575.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19814.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18575.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19814.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 17614.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18154.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 18402.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 18402.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 18575.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13275.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13523.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12804.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12235.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 22383.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 34115.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 21052.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 21052.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 13622.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20458.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 18402.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 17614.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18575.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5291.61, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18699.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16099.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12012.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6792.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18154.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5291.61, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13523.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 18328.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 17213.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 16099.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5291.61, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5291.61, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LEVETIRACETAM 500 MG/5 ML INTRAVENOUS SOLUTION (PEDIATRICS)", "code_information": [{"code": "J1953", "type": "HCPCS"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.83, "maximum": 12.89, "gross_charge": 7.9, "discounted_cash": 4.74, "payers_information": [{"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 12.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 12.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 12.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LEVETIRACETAM 500 MG/5 ML INTRAVENOUS SOLUTION", "code_information": [{"code": "J1953", "type": "HCPCS"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.83, "maximum": 12.89, "gross_charge": 7.9, "discounted_cash": 4.74, "payers_information": [{"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 12.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 12.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 12.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LEVOCARNITINE 200 MG/ML INTRAVENOUS SOLUTION", "code_information": [{"code": "J1955", "type": "HCPCS"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 35.59, "maximum": 166.22, "gross_charge": 195.55, "discounted_cash": 117.33, "payers_information": [{"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 156.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 97.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 147.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 146.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 146.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 156.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 143.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 144.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 135.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 143.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 145.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 145.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 146.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 145.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 82.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 96.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 98.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 150.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 166.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 166.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 107.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 161.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 146.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 156.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 82.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 146.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 143.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 145.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 113.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 98.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 150.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 166.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 161.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 143.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 143.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 146.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 147.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 166.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 147.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 98.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 150.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 161.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 146.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 146.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 113.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 146.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 145.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 146.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LEVOCARNITINE IV SYRINGE 200 MG/ML (PEDIATRICS)", "code_information": [{"code": "J1955", "type": "HCPCS"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 35.59, "maximum": 166.22, "gross_charge": 195.55, "discounted_cash": 117.33, "payers_information": [{"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 146.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 146.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 98.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 150.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 161.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 147.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 166.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 147.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 146.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 143.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 143.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 98.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 150.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 166.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 161.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 143.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 145.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 113.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 146.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 146.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 156.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 82.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 98.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 150.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 166.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 166.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 107.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 161.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 96.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 145.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 82.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 143.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 145.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 145.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 146.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 144.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 135.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 143.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 146.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 156.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 146.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 147.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 97.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 146.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 145.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 156.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 146.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 113.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LEVOCARNITINE 200 MG/ML INTRAVENOUS SOLUTION (USE WITH TPN CALCULATOR)", "code_information": [{"code": "J1955", "type": "HCPCS"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 35.59, "maximum": 166.22, "gross_charge": 195.55, "discounted_cash": 117.33, "payers_information": [{"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 113.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 146.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 156.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 145.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 146.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 146.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 156.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 82.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 146.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 143.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 145.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 113.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 98.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 150.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 166.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 161.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 143.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 143.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 146.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 147.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 166.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 147.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 98.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 150.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 161.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 146.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 146.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 97.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 147.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 146.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 146.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 156.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 143.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 144.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 135.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 143.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 145.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 145.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 146.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 145.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 82.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 96.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 98.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 150.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 166.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 166.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 107.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 161.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK", "code_information": [{"code": "J1956", "type": "HCPCS"}], "drug_information": {"unit": 100, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 13.24, "maximum": 29.24, "gross_charge": 34.4, "discounted_cash": 20.64, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 18.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 27.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 18.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 27.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 18.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 27.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LEVOFLOXACIN IV SYRINGE 5 MG/ML (PEDIATRICS)", "code_information": [{"code": "J1956", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 6.62, "maximum": 13.93, "gross_charge": 16.25, "discounted_cash": 9.75, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 9.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 13.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 9.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 13.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 9.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 13.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LIDOCAINE (PF) 8 MG/ML (0.8 %) IN 5 % DEXTROSE INTRAVENOUS SOLUTION", "code_information": [{"code": "J2002", "type": "HCPCS"}], "drug_information": {"unit": 250, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 10.62, "maximum": 128.94, "gross_charge": 21.9, "discounted_cash": 13.14, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 60.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 84.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 128.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 60.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 84.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 128.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 84.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 128.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LIDOCAINE INFUSION (PEDIATRICS)", "code_information": [{"code": "J2002", "type": "HCPCS"}], "drug_information": {"unit": 250, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 24.25, "maximum": 128.94, "gross_charge": 50.0, "discounted_cash": 30.0, "payers_information": [{"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 60.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 84.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 128.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 84.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 128.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 60.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 84.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 128.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LIDOCAINE HCL 10 MG/ML (1 %) INJECTION SOLUTION", "code_information": [{"code": "J2003", "type": "HCPCS"}], "drug_information": {"unit": 20, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 5.04, "maximum": 8.84, "gross_charge": 10.4, "discounted_cash": 6.24, "payers_information": [{"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LIDOCAINE HCL 20 MG/ML (2 %) INJECTION SOLUTION", "code_information": [{"code": "J2003", "type": "HCPCS"}], "drug_information": {"unit": 20, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 7.03, "maximum": 12.33, "gross_charge": 14.5, "discounted_cash": 8.7, "payers_information": [{"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LIDOCAINE (PF) 40 MG/ML (4 %) INJECTION SOLUTION", "code_information": [{"code": "J2003", "type": "HCPCS"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 8.58, "maximum": 15.05, "gross_charge": 17.7, "discounted_cash": 10.62, "payers_information": [{"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN (SO)", "code_information": [{"code": "J2003", "type": "HCPCS"}], "drug_information": {"unit": 2, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 6.11, "maximum": 10.71, "gross_charge": 12.6, "discounted_cash": 7.56, "payers_information": [{"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN (SO) (FOR ANESTHESIA OSM)", "code_information": [{"code": "J2003", "type": "HCPCS"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.94, "maximum": 29.07, "gross_charge": 34.2, "discounted_cash": 20.52, "payers_information": [{"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN (SO) (FOR ANESTHESIA OSM)", "code_information": [{"code": "J2003", "type": "HCPCS"}], "drug_information": {"unit": 2, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.94, "maximum": 29.07, "gross_charge": 4.0, "discounted_cash": 2.4, "payers_information": [{"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN (SO) (FOR ANESTHESIA OSM)", "code_information": [{"code": "J2003", "type": "HCPCS"}], "drug_information": {"unit": 30, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.94, "maximum": 29.07, "gross_charge": 9.75, "discounted_cash": 5.85, "payers_information": [{"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN (SO) (FOR ANESTHESIA OSM)", "code_information": [{"code": "J2003", "type": "HCPCS"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.94, "maximum": 29.07, "gross_charge": 5.4, "discounted_cash": 3.24, "payers_information": [{"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LIDOCAINE-EPINEPHRINE 0.5 %-1:200,000 INJECTION SOLUTION", "code_information": [{"code": "J2004", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 10.58, "maximum": 36.93, "gross_charge": 43.45, "discounted_cash": 26.07, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 35.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 10.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 16.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 35.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 10.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 16.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 10.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 16.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LIDOCAINE 1 %-EPINEPHRINE 1:100,000 INJECTION SOLUTION", "code_information": [{"code": "J2004", "type": "HCPCS"}], "drug_information": {"unit": 20, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 8.46, "maximum": 28.0, "gross_charge": 26.65, "discounted_cash": 15.99, "payers_information": [{"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 12.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 12.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 28.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 12.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 28.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LIDOCAINE-EPINEPHRINE (PF) 1 %-1:200,000 INJECTION SOLUTION", "code_information": [{"code": "J2004", "type": "HCPCS"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 4.23, "maximum": 47.05, "gross_charge": 52.6, "discounted_cash": 31.56, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 14.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 14.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LIDOCAINE-EPINEPHRINE (PF) 1 %-1:200,000 INJECTION SOLUTION", "code_information": [{"code": "J2004", "type": "HCPCS"}], "drug_information": {"unit": 30, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 4.23, "maximum": 47.05, "gross_charge": 55.35, "discounted_cash": 33.21, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 42.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 12.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 19.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 42.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 12.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 19.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 12.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 19.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LIDOCAINE-EPINEPHRINE (PF) 1.5 %-1:200,000 INJECTION SOLUTION", "code_information": [{"code": "J2004", "type": "HCPCS"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.17, "maximum": 16.79, "gross_charge": 19.75, "discounted_cash": 11.85, "payers_information": [{"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LIDOCAINE 2 %-EPINEPHRINE BITARTRATE 1:100,000 INJECTION CARTRIDGE", "code_information": [{"code": "J2004", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.44, "maximum": 5.31, "gross_charge": 6.25, "discounted_cash": 3.75, "payers_information": [{"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK", "code_information": [{"code": "J2020", "type": "HCPCS"}], "drug_information": {"unit": 300, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 21.83, "maximum": 52.99, "gross_charge": 45.0, "discounted_cash": 27.0, "payers_information": [{"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 34.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 52.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 35.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 35.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 34.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 52.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 34.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 52.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LINEZOLID IV SYRINGE 2 MG/ML (PEDIATRICS)", "code_information": [{"code": "J2020", "type": "HCPCS"}], "drug_information": {"unit": 300, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 21.83, "maximum": 52.99, "gross_charge": 45.0, "discounted_cash": 27.0, "payers_information": [{"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 34.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 52.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 35.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 34.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 52.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 34.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 52.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 35.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LORAZEPAM 2 MG/ML INJECTION SOLUTION (SO)", "code_information": [{"code": "J2060", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.18, "maximum": 9.09, "gross_charge": 6.55, "discounted_cash": 3.93, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 9.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 9.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 9.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MANNITOL 25 % INTRAVENOUS SOLUTION", "code_information": [{"code": "J2151", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.25, "maximum": 9.31, "gross_charge": 10.95, "discounted_cash": 6.57, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MEPERIDINE (PF) 50 MG/ML INJECTION SOLUTION (SO)", "code_information": [{"code": "J2175", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 6.43, "maximum": 53.03, "gross_charge": 13.25, "discounted_cash": 7.95, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 53.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 34.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 52.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 53.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 34.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 52.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 34.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 52.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MEPOLIZUMAB 100 MG SUBCUTANEOUS SOLUTION", "code_information": [{"code": "J2182", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 3188.5, "maximum": 20559.48, "gross_charge": 13848.75, "discounted_cash": 8309.25, "payers_information": [{"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 10386.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3188.5, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3188.5, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10386.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7506.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7561.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3188.5, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11079.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3188.5, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3188.5, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10289.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10386.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3188.5, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 8032.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10386.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10151.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 10289.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10289.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 10386.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10289.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 10590.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7561.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7159.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6841.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7422.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 13489.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 20559.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 11771.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 11771.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7616.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11439.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3188.5, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3188.5, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7561.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 9001.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 7616.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 7616.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3188.5, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10151.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4571.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10455.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9001.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6716.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3188.5, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10386.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7561.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10386.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11079.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3188.5, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11079.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 10590.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3188.5, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7506.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7506.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 10386.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9001.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10151.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10151.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10151.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10289.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 8032.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 13489.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 20559.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 11771.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11439.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10386.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10455.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11771.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10455.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9001.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 13489.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 20559.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11439.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MEROPENEM 1 GRAM/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK", "code_information": [{"code": "J2184", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 69.65, "maximum": 129.58, "gross_charge": 143.6, "discounted_cash": 86.16, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 107.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 70.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 85.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 129.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 122.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 122.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 118.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 107.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 107.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 70.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 107.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 85.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 129.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 122.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 118.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 107.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 122.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 85.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 129.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 118.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 107.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 107.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 107.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 107.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MEROPENEM 1 GRAM INTRAVENOUS SOLUTION", "code_information": [{"code": "J2185", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 12.97, "maximum": 24.5, "gross_charge": 26.75, "discounted_cash": 16.05, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 24.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 24.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 24.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "J2185", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 17.39, "maximum": 20.06, "gross_charge": 26.75, "discounted_cash": 16.05, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MEROPENEM IV SYRINGE 20 MG/ML (PEDIATRICS)", "code_information": [{"code": "J2185", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 14.9, "maximum": 60.52, "gross_charge": 71.2, "discounted_cash": 42.72, "payers_information": [{"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 24.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 24.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 24.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MEROPENEM IV SYRINGE 20 MG/ML (PEDIATRICS)|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "J2185", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 46.28, "maximum": 53.4, "gross_charge": 71.2, "discounted_cash": 42.72, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MEROPENEM IVPB 20 MG/ML (PEDIATRICS)", "code_information": [{"code": "J2185", "type": "HCPCS"}], "drug_information": {"unit": 100, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 25.85, "maximum": 49.0, "gross_charge": 53.3, "discounted_cash": 31.98, "payers_information": [{"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 29.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 29.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 32.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 49.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 32.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 49.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 32.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 49.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MEROPENEM IVPB 20 MG/ML (PEDIATRICS)|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "J2185", "type": "HCPCS"}], "drug_information": {"unit": 100, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 34.65, "maximum": 39.98, "gross_charge": 53.3, "discounted_cash": 31.98, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MEROPENEM-VABORBACTAM 2 GRAM INTRAVENOUS SOLUTION", "code_information": [{"code": "J2186", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 218.4, "maximum": 791.0, "gross_charge": 988.75, "discounted_cash": 593.25, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 724.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 737.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 488.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 529.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 543.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 218.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 218.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 543.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 218.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 724.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 494.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 218.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 791.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 791.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 737.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 218.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 218.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 535.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 741.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 724.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 724.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 724.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 573.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 741.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 218.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 218.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 535.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 218.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 791.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 218.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 218.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 218.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 573.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MEROPENEM-VABORBACTAM IV SYRINGE 8 MG/ML (PEDIATRICS)", "code_information": [{"code": "J2186", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 87.36, "maximum": 346.24, "gross_charge": 432.8, "discounted_cash": 259.68, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 251.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 87.36, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 317.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 251.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 317.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 317.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 234.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 87.36, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 87.36, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 346.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 294.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 346.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 87.36, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 216.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 317.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 87.36, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 238.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 317.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 213.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 294.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 87.36, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 87.36, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 238.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 231.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 87.36, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 87.36, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 346.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 87.36, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 234.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 87.36, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 87.36, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MEROPENEM-VABORBACTAM IVPB 8 MG/ML (PEDIATRICS)", "code_information": [{"code": "J2186", "type": "HCPCS"}], "drug_information": {"unit": 100, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 174.72, "maximum": 692.48, "gross_charge": 865.6, "discounted_cash": 519.36, "payers_information": [{"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 649.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 174.72, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 174.72, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 469.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 174.72, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 692.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 174.72, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 174.72, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 463.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 476.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 174.72, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 174.72, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 589.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 427.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 634.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 476.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 174.72, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 634.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 432.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 174.72, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 692.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 692.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 589.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 174.72, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 174.72, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 469.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 649.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 634.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 634.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 634.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 502.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 174.72, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 502.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "METHYLERGONOVINE 0.2 MG/ML (1 ML) INJECTION SOLUTION", "code_information": [{"code": "J2210", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 61.93, "maximum": 137.71, "gross_charge": 127.7, "discounted_cash": 76.62, "payers_information": [{"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 95.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 96.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 96.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 90.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 137.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 95.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 95.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 95.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 95.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 95.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 74.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 90.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 137.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 96.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 95.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 95.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 74.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 95.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 90.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 137.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "METHYLNALTREXONE 12 MG/0.6 ML SUBCUTANEOUS SYRINGE", "code_information": [{"code": "J2212", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "minimum": 134.33, "maximum": 1206.88, "gross_charge": 738.1, "discounted_cash": 442.86, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 541.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 548.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 548.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 553.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 548.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 775.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 403.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 381.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 364.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 395.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 791.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1206.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 627.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 627.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 405.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 609.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 152.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 134.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 403.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 546.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 512.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 479.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 541.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 369.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 557.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 479.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 357.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 553.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 403.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 553.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 590.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 553.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 590.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 775.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 172.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 400.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 400.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 553.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 479.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 541.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 541.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 541.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 548.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 428.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 791.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1206.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 627.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 609.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 553.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 557.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 627.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 557.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 479.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 791.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1206.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 609.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 553.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 172.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 172.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 553.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 400.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 403.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 172.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 590.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 548.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 553.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 428.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 553.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MICAFUNGIN 50 MG INTRAVENOUS SOLUTION", "code_information": [{"code": "J2248", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 46.71, "maximum": 81.86, "gross_charge": 96.3, "discounted_cash": 57.78, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 52.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 52.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 80.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 52.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 52.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 80.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 52.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 80.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MIDAZOLAM 5 MG/ML INJECTION SOLUTION", "code_information": [{"code": "J2250", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 2.7, "maximum": 45.13, "gross_charge": 7.4, "discounted_cash": 4.44, "payers_information": [{"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MIDAZOLAM 5 MG/ML INJECTION SOLUTION", "code_information": [{"code": "J2250", "type": "HCPCS"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 2.7, "maximum": 45.13, "gross_charge": 10.5, "discounted_cash": 6.3, "payers_information": [{"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 29.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 45.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 29.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 45.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 27.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 29.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 45.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 27.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MIDAZOLAM 5 MG/ML INJECTION SOLUTION", "code_information": [{"code": "J2250", "type": "HCPCS"}], "drug_information": {"unit": 2, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 2.7, "maximum": 45.13, "gross_charge": 7.75, "discounted_cash": 4.65, "payers_information": [{"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 9.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 9.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 9.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MIDAZOLAM 5 MG/ML INJECTION SOLUTION", "code_information": [{"code": "J2250", "type": "HCPCS"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 2.7, "maximum": 45.13, "gross_charge": 33.45, "discounted_cash": 20.07, "payers_information": [{"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 14.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 22.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 14.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 22.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 13.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 14.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 22.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 13.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MIDAZOLAM (PF) 5 MG/ML INJECTION SOLUTION", "code_information": [{"code": "J2250", "type": "HCPCS"}], "drug_information": {"unit": 2, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.03, "maximum": 9.03, "gross_charge": 6.25, "discounted_cash": 3.75, "payers_information": [{"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 9.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 9.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 9.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MIDAZOLAM (PF) 1 MG/ML INJECTION SOLUTION", "code_information": [{"code": "J2250", "type": "HCPCS"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 2.57, "maximum": 4.51, "gross_charge": 5.3, "discounted_cash": 3.18, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MIDAZOLAM INFUSION 1 MG/ML (SYRINGE) (PEDIATRICS)", "code_information": [{"code": "J2250", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 27.0, "maximum": 57.67, "gross_charge": 67.85, "discounted_cash": 40.71, "payers_information": [{"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 29.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 45.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 29.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 45.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 29.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 45.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 27.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 27.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MIDAZOLAM INFUSION 5 MG/ML (SYRINGE) (PEDIATRICS)", "code_information": [{"code": "J2250", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 25.39, "maximum": 225.65, "gross_charge": 52.35, "discounted_cash": 31.41, "payers_information": [{"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 135.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 135.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 148.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 225.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 148.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 225.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 148.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 225.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MIDAZOLAM (PF) 1 MG/ML INJECTION SOLUTION (PEDIATRICS)", "code_information": [{"code": "J2250", "type": "HCPCS"}], "drug_information": {"unit": 2, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.08, "maximum": 4.51, "gross_charge": 5.0, "discounted_cash": 3.0, "payers_information": [{"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MIDAZOLAM (PF) 1 MG/ML INJECTION SOLUTION (PEDIATRICS)", "code_information": [{"code": "J2250", "type": "HCPCS"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.08, "maximum": 4.51, "gross_charge": 5.3, "discounted_cash": 3.18, "payers_information": [{"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MILRINONE 20 MG/100 ML(200 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS PIGGYBK", "code_information": [{"code": "J2260", "type": "HCPCS"}], "drug_information": {"unit": 100, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 13.05, "maximum": 34.81, "gross_charge": 26.9, "discounted_cash": 16.14, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 18.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 22.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 34.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 18.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 22.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 34.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 22.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 34.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MILRINONE 1 MG/ML INTRAVENOUS SOLUTION", "code_information": [{"code": "J2260", "type": "HCPCS"}], "drug_information": {"unit": 20, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 14.26, "maximum": 34.81, "gross_charge": 29.4, "discounted_cash": 17.64, "payers_information": [{"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 22.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 34.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 22.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 34.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 18.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 22.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 34.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 18.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MILRINONE INFUSION 200 MCG/ML (PEDIATRICS)", "code_information": [{"code": "J2260", "type": "HCPCS"}], "drug_information": {"unit": 100, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 13.05, "maximum": 34.81, "gross_charge": 26.9, "discounted_cash": 16.14, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 18.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 22.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 34.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 18.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 22.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 34.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 22.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 34.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MORPHINE PCA 1 MG/ML IN 0.9 % SODIUM CHLORIDE INJECTABLE PUMP RESERVOIR", "code_information": [{"code": "J2270", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 2.3, "maximum": 97.99, "gross_charge": 4.75, "discounted_cash": 2.85, "payers_information": [{"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 64.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 97.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 76.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 64.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 97.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 76.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 64.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 97.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MORPHINE (PF) 50 MG/50 ML(1 MG/ML) IN 0.9% NACL IV PUMP RESERVOIR", "code_information": [{"code": "J2270", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 64.3, "maximum": 276.0, "gross_charge": 324.7, "discounted_cash": 194.82, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 238.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 241.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 241.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 243.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 245.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 211.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 276.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 245.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 243.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 238.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 238.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 177.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 64.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 97.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 276.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 268.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 238.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 241.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 188.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 243.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 211.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 175.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 175.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 198.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 259.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 76.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 243.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 259.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 243.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 162.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 245.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 211.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 157.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 211.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 193.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 178.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 238.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 177.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 174.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 64.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 97.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 276.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 276.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 178.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 268.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 177.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 167.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 160.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 241.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 76.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 243.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 188.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 243.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 241.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 259.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 177.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 175.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 243.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 243.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 64.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 97.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 268.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MORPHINE 50 MG/50 ML (1 MG/ML) IN 0.9 % SODIUM CHLORIDE CARTRIDGE", "code_information": [{"code": "J2270", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 64.3, "maximum": 210.29, "gross_charge": 247.4, "discounted_cash": 148.44, "payers_information": [{"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 64.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 97.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 204.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 185.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 185.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 134.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 135.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 197.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 183.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 185.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 143.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 185.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 135.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 181.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 181.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 185.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 186.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 210.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 186.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 160.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 150.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 197.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 76.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 134.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 134.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 185.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 160.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 181.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 183.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 143.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 64.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 97.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 210.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 204.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 183.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 76.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 135.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 122.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 64.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 97.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 210.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 210.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 204.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 132.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 135.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 181.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 160.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 147.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 186.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 160.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 119.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 123.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 185.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 185.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 197.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 181.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 183.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 183.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 185.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MORPHINE 10 MG/ML INJECTION SOLUTION (SO)", "code_information": [{"code": "J2270", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 7.61, "maximum": 19.6, "gross_charge": 15.7, "discounted_cash": 9.42, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 12.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 19.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 15.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 12.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 19.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 15.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 12.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 19.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MORPHINE 50 MG/50 ML (1 MG/ML) IN 0.9 % SODIUM CHLORIDE CARTRIDGE (PEDIATRIC)", "code_information": [{"code": "J2270", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 64.3, "maximum": 179.14, "gross_charge": 210.75, "discounted_cash": 126.45, "payers_information": [{"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 158.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 158.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 115.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 168.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 64.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 97.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 174.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 156.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 158.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 122.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 158.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 115.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 154.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 154.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 158.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 159.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 179.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 159.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 128.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 168.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 76.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 158.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 154.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 156.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 122.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 64.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 97.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 179.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 174.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 115.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 154.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 125.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 115.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 159.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 158.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 158.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 168.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 156.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 76.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 115.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 64.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 97.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 179.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 179.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 115.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 174.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 154.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 156.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 156.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 158.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MORPHINE 50 MG/50 ML (1 MG/ML) IN 0.9% SODIUM CHLORIDE CARTRIDGE (PREMIX)", "code_information": [{"code": "J2270", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 2.3, "maximum": 97.99, "gross_charge": 4.75, "discounted_cash": 2.85, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 64.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 97.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 76.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 64.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 97.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 76.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 64.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 97.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MORPHINE 2 MG/ML INJECTION (SO) (PEDIATRICS)|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "J2270", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 5.91, "maximum": 19.6, "gross_charge": 10.75, "discounted_cash": 6.45, "payers_information": [{"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 12.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 19.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 15.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 12.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 19.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 15.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 12.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 19.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MORPHINE 2 MG/ML INJECTION (SO)", "code_information": [{"code": "J2272", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 5.21, "maximum": 43.65, "gross_charge": 10.75, "discounted_cash": 6.45, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 27.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 28.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 43.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 28.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 43.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 27.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 28.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 43.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MORPHINE 2 MG/ML INJECTION (SO) (PEDIATRICS)", "code_information": [{"code": "J2272", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 5.21, "maximum": 43.65, "gross_charge": 10.75, "discounted_cash": 6.45, "payers_information": [{"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 27.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 28.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 43.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 28.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 43.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 28.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 43.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 27.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MORPHINE (PF) 1 MG/ML INJECTION SOLUTION", "code_information": [{"code": "J2274", "type": "HCPCS"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 36.47, "maximum": 96.86, "gross_charge": 113.95, "discounted_cash": 68.37, "payers_information": [{"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 57.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 87.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 96.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 96.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 57.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 87.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 36.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 57.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 87.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 96.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 96.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 36.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MORPHINE (PF) 25 MG/ML INJECTION SOLUTION", "code_information": [{"code": "J2274", "type": "HCPCS"}], "drug_information": {"unit": 20, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 737.54, "maximum": 4351.73, "gross_charge": 1520.7, "discounted_cash": 912.42, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1114.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 1129.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1129.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 1140.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1140.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 830.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 824.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 824.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1140.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1216.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1823.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1140.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1216.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1140.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 760.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1148.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 988.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 737.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1114.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 830.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 1125.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1056.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 988.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2855.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 4351.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1292.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 1292.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 836.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1256.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 815.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 830.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 786.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 751.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1129.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1823.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2855.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 4351.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 1292.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1256.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1114.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1129.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 882.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1114.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 988.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 882.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1140.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1129.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1216.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 830.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 824.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1140.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1140.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2855.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 4351.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1256.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1148.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 988.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1292.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1148.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1140.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1114.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1140.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MORPHINE (PF) 25 MG/ML INJECTION SOLUTION|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "J2274", "type": "HCPCS"}], "drug_information": {"unit": 20, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 836.39, "maximum": 988.46, "gross_charge": 1520.7, "discounted_cash": 912.42, "payers_information": [{"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 988.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 904.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 836.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 927.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MORPHINE (PF) 0.5 MG/ML INJECTION SOLUTION", "code_information": [{"code": "J2274", "type": "HCPCS"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 27.45, "maximum": 87.03, "gross_charge": 56.6, "discounted_cash": 33.96, "payers_information": [{"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 57.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 87.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 57.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 87.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 36.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 57.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 87.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 36.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MORPHINE (PF) 0.5 MG/ML INJECTION SOLUTION (FROM 0.5 MG/ML)", "code_information": [{"code": "J2274", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 36.47, "maximum": 96.18, "gross_charge": 113.15, "discounted_cash": 67.89, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 36.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 57.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 87.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 96.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 96.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 36.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 57.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 87.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 96.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 57.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 87.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 96.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MORPHINE (PF) 10 MG/ML INJECTION SOLUTION", "code_information": [{"code": "J2274", "type": "HCPCS"}], "drug_information": {"unit": 20, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 479.47, "maximum": 1740.69, "gross_charge": 988.6, "discounted_cash": 593.16, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 734.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 729.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 529.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 539.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 511.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 488.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 731.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 687.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 642.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1142.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1740.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 840.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 840.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 543.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 816.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 741.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 790.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 729.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 535.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 535.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 539.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 539.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 724.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 746.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 642.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 479.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 494.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 741.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 741.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 790.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 724.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 734.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 734.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 741.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 741.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 724.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 741.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 746.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 840.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 746.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 642.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1142.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1740.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 816.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 741.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 741.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 535.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 539.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 790.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 734.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 741.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 573.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 741.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 642.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 724.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 724.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 734.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 573.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1142.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1740.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 840.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 816.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MORPHINE (PF) 10 MG/ML INJECTION SOLUTION|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "J2274", "type": "HCPCS"}], "drug_information": {"unit": 20, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 543.73, "maximum": 642.59, "gross_charge": 988.6, "discounted_cash": 593.16, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 603.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 642.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 588.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 543.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MOXIFLOXACIN 400 MG/250 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK", "code_information": [{"code": "J2280", "type": "HCPCS"}], "drug_information": {"unit": 250, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 106.94, "maximum": 236.22, "gross_charge": 220.5, "discounted_cash": 132.3, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 161.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 163.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 163.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 165.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 163.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 117.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 118.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 154.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 236.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 187.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 187.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 121.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 182.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 143.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 131.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 121.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 161.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 110.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 166.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 143.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 165.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 165.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 176.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 134.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 176.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 117.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 119.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 119.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 165.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 143.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 161.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 161.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 161.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 163.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 154.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 236.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 187.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 182.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 165.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 166.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 187.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 166.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 143.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 154.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 236.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 182.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 165.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 165.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 119.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 176.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 163.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 165.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 165.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "NAFCILLIN 10 GRAM SOLUTION FOR INJECTION", "code_information": [{"code": "J2290", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 84.38, "maximum": 136.64, "gross_charge": 170.8, "discounted_cash": 102.48, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 125.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 100.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 125.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 100.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 128.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 125.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 125.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 125.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 128.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "NAFCILLIN 2 GRAM SOLUTION FOR INJECTION", "code_information": [{"code": "J2290", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 17.64, "maximum": 28.56, "gross_charge": 35.7, "discounted_cash": 21.42, "payers_information": [{"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 20.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 20.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "NALBUPHINE IV SYRINGE 1 MG/ML (PEDIATRICS)", "code_information": [{"code": "J2300", "type": "HCPCS"}], "drug_information": {"unit": 200, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 152.85, "maximum": 444.84, "gross_charge": 315.15, "discounted_cash": 189.09, "payers_information": [{"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 252.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 234.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 236.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 182.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 237.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 204.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 291.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 444.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 260.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 236.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 236.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 170.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 172.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 236.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 231.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 234.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 234.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 236.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 234.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 237.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 172.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 162.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 155.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 168.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 291.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 444.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 267.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 267.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 173.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 260.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 204.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 187.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 173.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 172.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 231.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 237.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 204.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 152.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 157.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 236.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 236.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 252.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 192.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 252.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 237.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 170.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 170.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 236.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 204.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 172.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 231.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 231.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 234.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 182.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 291.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 444.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 267.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 260.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 231.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 236.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 237.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 267.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "NALBUPHINE 10 MG/ML INJECTION SOLUTION", "code_information": [{"code": "J2300", "type": "HCPCS"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 68.31, "maximum": 222.42, "gross_charge": 140.85, "discounted_cash": 84.51, "payers_information": [{"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 118.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 119.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 145.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 222.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 119.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 116.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 118.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 145.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 222.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 119.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 119.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 116.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 145.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 222.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 116.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "NITROGLYCERIN 50 MG/250 ML (200 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS", "code_information": [{"code": "J2305", "type": "HCPCS"}], "drug_information": {"unit": 250, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 43.94, "maximum": 97.99, "gross_charge": 90.6, "discounted_cash": 54.36, "payers_information": [{"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 64.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 97.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 48.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 64.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 97.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 48.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 64.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 97.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "NITROGLYCERIN 50 MG/250 ML (200 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "J2305", "type": "HCPCS"}], "drug_information": {"unit": 250, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 53.91, "maximum": 55.27, "gross_charge": 90.6, "discounted_cash": 54.36, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "NITROGLYCERIN 200 MCG/ML IN DEXTROSE 5% INFUSION (PEDIATRICS)", "code_information": [{"code": "J2305", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 9.6, "maximum": 19.6, "gross_charge": 20.5, "discounted_cash": 12.3, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 12.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 19.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 9.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 12.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 19.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 12.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 19.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 9.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "NITROGLYCERIN 200 MCG/ML IN DEXTROSE 5% INFUSION (PEDIATRICS)|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "J2305", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 12.2, "maximum": 12.51, "gross_charge": 20.5, "discounted_cash": 12.3, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "NITROGLYCERIN 200 MCG/ML IN 5 % DEXTROSE 10 ML", "code_information": [{"code": "J2305", "type": "HCPCS"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.92, "maximum": 9.8, "gross_charge": 3.95, "discounted_cash": 2.37, "payers_information": [{"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 9.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 9.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 9.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "NITROGLYCERIN 200 MCG/ML IN 5 % DEXTROSE 10 ML|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "J2305", "type": "HCPCS"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 2.35, "maximum": 2.41, "gross_charge": 3.95, "discounted_cash": 2.37, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "NALOXONE 0.4 MG/ML INJECTION SOLUTION", "code_information": [{"code": "J2312", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 9.6, "maximum": 23.33, "gross_charge": 27.45, "discounted_cash": 16.47, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 9.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 9.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "NUSINERSEN (PF) 12 MG/5 ML INTRATHECAL SOLUTION", "code_information": [{"code": "J2326", "type": "HCPCS"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 1126.0, "maximum": 439558.84, "gross_charge": 517128.05, "discounted_cash": 310276.83, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 379054.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 384226.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 384226.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 387846.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 384226.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 137044.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "fee schedule", "standard_charge_dollar": 183098.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "fee schedule", "standard_charge_dollar": 183098.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "fee schedule", "standard_charge_dollar": 183098.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 277180.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 1149.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 1126.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 439558.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 439558.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 284420.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 427147.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 154337.64, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 154337.64, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "fee schedule", "standard_charge_dollar": 183098.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 382674.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 359403.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 336133.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 154337.64, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 379054.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 187490.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 390431.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 336133.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 250807.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 154337.64, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 387846.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "fee schedule", "standard_charge_dollar": 183098.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 387846.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 413702.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 154337.64, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 387846.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 413702.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 137044.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 154337.64, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 280283.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 280283.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 387846.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 336133.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 379054.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 379054.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 379054.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 384226.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 299934.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 1149.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 1126.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 439558.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 427147.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 387846.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 390431.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 439558.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 390431.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 336133.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "per diem", "standard_charge_dollar": 1149.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "per diem", "standard_charge_dollar": 1126.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 427147.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 387846.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 154337.64, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 154337.64, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 387846.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 280283.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "fee schedule", "standard_charge_dollar": 183098.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 154337.64, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 413702.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 154337.64, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 154337.64, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 384226.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 387846.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 154337.64, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 299934.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 387846.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "RISANKIZUMAB-RZAA 60 MG/ML INTRAVENOUS SOLUTION", "code_information": [{"code": "J2327", "type": "HCPCS"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 8959.2, "maximum": 57752.23, "gross_charge": 48734.55, "discounted_cash": 29240.73, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35722.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 36209.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 36209.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 36550.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 36209.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 30096.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26609.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25195.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24074.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26121.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 37892.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 57752.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 41424.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 41424.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 26804.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40254.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 8959.2, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 8959.2, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26609.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 36063.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 33870.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 31677.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 8959.2, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35722.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 13358.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36794.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31677.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23636.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 8959.2, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36550.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26609.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36550.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38987.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 8959.2, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36550.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38987.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 30096.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 8959.2, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26414.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26414.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 36550.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31677.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35722.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35722.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35722.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 36209.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 28266.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 37892.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 57752.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 41424.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40254.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36550.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36794.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41424.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36794.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31677.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 37892.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 57752.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40254.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 36550.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 8959.2, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 8959.2, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36550.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26414.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26609.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 8959.2, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38987.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 8959.2, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 8959.2, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 36209.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36550.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 8959.2, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 28266.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36550.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OCRELIZUMAB 30 MG/ML INTRAVENOUS SOLUTION", "code_information": [{"code": "J2350", "type": "HCPCS"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 17797.2, "maximum": 114730.81, "gross_charge": 97309.3, "discounted_cash": 58385.58, "payers_information": [{"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 17797.2, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52741.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52741.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 72981.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 63251.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71327.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71327.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71327.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 72300.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 56439.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 75277.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 114730.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 82712.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80377.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 72981.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73468.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82712.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73468.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 63251.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 75277.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 114730.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80377.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 72981.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 17797.2, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 17797.2, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 72981.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52741.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53130.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 17797.2, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77847.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 17797.2, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 17797.2, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 72300.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 72981.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 17797.2, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 56439.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 72981.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 17797.2, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71327.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 26023.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73468.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 63251.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47195.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 17797.2, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 72981.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53130.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 72981.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77847.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 17797.2, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77847.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 60537.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71327.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 72300.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 72300.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 72981.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 72300.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 60537.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53130.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50308.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48070.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52157.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 75277.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 114730.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 82712.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 82712.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 53520.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80377.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 17797.2, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 17797.2, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53130.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 63251.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 53520.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 53520.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OCRELIZUMAB 30 MG/ML INTRAVENOUS SOLUTION|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "J2350", "type": "HCPCS"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 63251.05, "maximum": 72981.98, "gross_charge": 97309.3, "discounted_cash": 58385.58, "payers_information": [{"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 72008.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 67629.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 63251.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 72981.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OCTREOTIDE ACETATE 50 MCG/ML INJECTION SOLUTION (SO)", "code_information": [{"code": "J2354", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 4.12, "maximum": 10.24, "gross_charge": 12.05, "discounted_cash": 7.23, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION (SO)", "code_information": [{"code": "J2354", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.9, "maximum": 17.02, "gross_charge": 8.05, "discounted_cash": 4.83, "payers_information": [{"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 17.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 17.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 17.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OLANZAPINE 10 MG INTRAMUSCULAR SOLUTION", "code_information": [{"code": "J2359", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 37.15, "maximum": 104.44, "gross_charge": 76.6, "discounted_cash": 45.96, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 61.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 68.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 104.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 61.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 68.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 104.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 68.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 104.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PHENYLEPHRINE 10 MG/ML INJECTION SOLUTION", "code_information": [{"code": "J2371", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 2.81, "maximum": 32.24, "gross_charge": 5.8, "discounted_cash": 3.48, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 15.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 21.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 32.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 15.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 21.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 32.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 21.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 32.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CHLOROPROCAINE (PF) 30 MG/ML (3 %) INJECTION SOLUTION", "code_information": [{"code": "J2401", "type": "HCPCS"}], "drug_information": {"unit": 20, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 51.39, "maximum": 154.73, "gross_charge": 105.95, "discounted_cash": 63.57, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 84.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 101.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 154.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 84.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 101.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 154.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 101.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 154.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "NICARDIPINE 25 MG/10 ML INTRAVENOUS SOLUTION", "code_information": [{"code": "J2404", "type": "HCPCS"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 29.15, "maximum": 112.82, "gross_charge": 60.1, "discounted_cash": 36.06, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 75.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 74.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 112.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 75.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 74.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 112.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 74.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 112.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION", "code_information": [{"code": "J2405", "type": "HCPCS"}], "drug_information": {"unit": 20, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 12.0, "maximum": 27.88, "gross_charge": 32.8, "discounted_cash": 19.68, "payers_information": [{"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 15.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 23.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 12.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 15.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 23.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 12.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 15.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 23.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ONDANSETRON HCL (PF) 4 MG/2 ML INJ (SO)", "code_information": [{"code": "J2405", "type": "HCPCS"}], "drug_information": {"unit": 2, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.12, "maximum": 2.32, "gross_charge": 2.3, "discounted_cash": 1.38, "payers_information": [{"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ONDANSETRON HCL (PF) 4 MG/2 ML INJ (SO) (PEDIATRICS)", "code_information": [{"code": "J2405", "type": "HCPCS"}], "drug_information": {"unit": 2, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.12, "maximum": 2.32, "gross_charge": 2.3, "discounted_cash": 1.38, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PALIFERMIN 5.16 MG INTRAVENOUS SOLUTION", "code_information": [{"code": "J2425", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 3845.94, "maximum": 24796.13, "gross_charge": 17265.75, "discounted_cash": 10359.45, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12655.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 12828.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 12828.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 12949.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 12828.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 12744.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9427.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8926.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8529.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9254.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 16269.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 24796.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 14675.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 14675.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 9496.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14261.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3845.94, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3845.94, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9427.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 12776.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 11999.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 11222.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3845.94, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12655.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8632.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13035.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11222.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8373.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3845.94, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12949.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9427.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12949.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13812.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3845.94, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12949.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13812.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 12744.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3845.94, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9358.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9358.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 12949.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11222.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12655.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12655.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12655.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 12828.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 10014.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 16269.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 24796.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 14675.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14261.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12949.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13035.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14675.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13035.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11222.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 16269.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 24796.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14261.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 12949.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3845.94, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3845.94, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12949.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9358.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9427.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3845.94, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13812.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3845.94, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3845.94, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 12828.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12949.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3845.94, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 10014.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12949.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PALIPERIDONE PALMITATE 234 MG/1.5 ML INTRAMUSCULAR SYRINGE", "code_information": [{"code": "J2426", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 3535.97, "maximum": 22794.92, "gross_charge": 14345.25, "discounted_cash": 8607.15, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10515.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 10658.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10658.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 10758.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10658.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11926.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7832.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7416.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7086.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7689.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 14956.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 22794.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 12193.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 12193.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7889.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11849.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3535.97, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3535.97, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7832.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 9324.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 8535.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 7889.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3535.97, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10515.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7172.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10830.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9324.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6957.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3535.97, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10758.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7832.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10758.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11476.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3535.97, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8750.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11476.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11926.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3535.97, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7775.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7775.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 10758.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9324.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10515.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10515.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10515.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10658.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 8320.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 14956.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 22794.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 12193.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11849.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10758.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10830.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12193.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10830.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9324.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 14956.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 22794.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11849.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 10758.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3535.97, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3535.97, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10758.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7775.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7832.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3535.97, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11476.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3535.97, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3535.97, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10658.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10758.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3535.97, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 8320.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10758.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PAMIDRONATE 30 MG INTRAVENOUS SOLUTION", "code_information": [{"code": "J2430", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 37.72, "maximum": 91.8, "gross_charge": 108.0, "discounted_cash": 64.8, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 37.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 47.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 72.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 37.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 47.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 72.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 47.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 72.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PAMIDRONATE 30 MG/10 ML (3 MG/ML) INTRAVENOUS SOLUTION", "code_information": [{"code": "J2430", "type": "HCPCS"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 27.62, "maximum": 72.79, "gross_charge": 56.95, "discounted_cash": 34.17, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 47.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 72.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 47.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 72.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 37.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 47.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 72.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 37.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PAPAVERINE 30 MG/ML INJECTION SOLUTION", "code_information": [{"code": "J2440", "type": "HCPCS"}], "drug_information": {"unit": 2, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 14.36, "maximum": 241.76, "gross_charge": 78.9, "discounted_cash": 47.34, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 155.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 158.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 241.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 155.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 158.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 241.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 158.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 241.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION", "code_information": [{"code": "J2501", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 11.3, "maximum": 48.62, "gross_charge": 57.2, "discounted_cash": 34.32, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 20.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 31.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 20.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 31.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 20.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 31.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PEGFILGRASTIM 6 MG/0.6 ML (DELIVERABLE) WEARABLE SUBCUTANEOUS INJECTOR", "code_information": [{"code": "J2506", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "minimum": 1474.04, "maximum": 14990.09, "gross_charge": 17635.4, "discounted_cash": 10581.24, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12926.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 13103.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 13103.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 13226.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9452.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9628.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9117.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8711.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6235.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 9503.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 14990.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 14990.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 9699.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14566.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 13103.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2368.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1474.04, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1474.04, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 13050.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 12256.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 11463.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9628.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1474.04, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12926.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8471.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13314.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11463.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8553.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1474.04, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13226.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13226.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14108.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9628.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1474.04, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13226.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14108.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2368.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9558.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9558.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 13226.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11463.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1474.04, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12926.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6235.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 9503.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 14990.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14566.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12926.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 13103.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 10228.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12926.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13226.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13314.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14990.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13314.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11463.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6235.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 9503.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14566.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 13226.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1474.04, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1474.04, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13226.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9558.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9628.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1474.04, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14108.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1474.04, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1474.04, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 13103.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13226.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1474.04, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 10228.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13226.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PEGFILGRASTIM 6 MG/0.6 ML SUBCUTANEOUS SYRINGE", "code_information": [{"code": "J2506", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "minimum": 1474.04, "maximum": 14990.09, "gross_charge": 17635.4, "discounted_cash": 10581.24, "payers_information": [{"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13226.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 10228.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1474.04, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13226.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 13103.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1474.04, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1474.04, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14108.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1474.04, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9628.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9558.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13226.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1474.04, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1474.04, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 13226.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6235.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 9503.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14566.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13314.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11463.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14990.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13314.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13226.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12926.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12926.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 13103.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 10228.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6235.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 9503.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 14990.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14566.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12926.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1474.04, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 13226.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11463.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9558.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9558.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13226.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14108.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2368.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1474.04, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9628.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13226.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14108.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13226.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1474.04, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13314.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11463.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8553.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8471.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12926.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1474.04, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9628.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 13050.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 12256.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 11463.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1474.04, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1474.04, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 13103.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2368.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6235.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 9503.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 14990.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 14990.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 9699.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14566.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9628.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9117.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8711.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9452.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12926.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 13103.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 13103.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 13226.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PENTOBARBITAL INFUSION 8 MG/ML (PEDIATRICS)", "code_information": [{"code": "J2515", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 290.11, "maximum": 1724.32, "gross_charge": 2080.45, "discounted_cash": 1248.27, "payers_information": [{"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 290.11, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1664.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 290.11, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 290.11, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 290.11, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1206.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1524.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1724.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1027.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1115.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1144.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 290.11, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 290.11, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1144.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 290.11, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1524.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1040.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 290.11, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1664.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1664.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1724.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 290.11, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 290.11, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1127.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1560.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1524.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1524.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1524.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1206.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1560.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 290.11, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 290.11, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1127.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PENTOBARBITAL SODIUM 50 MG/ML INJECTION SOLUTION", "code_information": [{"code": "J2515", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 36.26, "maximum": 255.72, "gross_charge": 319.65, "discounted_cash": 191.79, "payers_information": [{"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 36.26, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 36.26, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 255.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 36.26, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 185.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 36.26, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 173.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 36.26, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 36.26, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 239.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 234.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 185.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 234.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 234.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 239.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 173.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 36.26, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 36.26, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 255.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 215.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 255.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 36.26, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 159.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 234.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 36.26, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 175.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 36.26, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 36.26, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 175.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 171.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 157.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 215.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 234.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PENTAMIDINE 300 MG SOLUTION FOR INJECTION", "code_information": [{"code": "J2516", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 99.39, "maximum": 160.96, "gross_charge": 201.2, "discounted_cash": 120.72, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 147.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 107.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 110.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 110.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 147.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 160.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 160.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 109.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 150.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 147.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 147.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 147.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 116.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 150.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 109.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 160.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 116.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PENICILLIN G IV SYRINGE 0.1 MILLION UNITS/ML (PEDIATRICS)", "code_information": [{"code": "J2540", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 14.04, "maximum": 45.26, "gross_charge": 28.95, "discounted_cash": 17.37, "payers_information": [{"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 29.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 45.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 29.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 45.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 26.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 26.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 29.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 45.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PENICILLIN G IV SYRINGE 0.1 MILLION UNITS/ML (PEDIATRICS)|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "J2540", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 23.76, "maximum": 40.23, "gross_charge": 28.95, "discounted_cash": 17.37, "payers_information": [{"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 26.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 40.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 23.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 23.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 26.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 40.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 26.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 40.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION", "code_information": [{"code": "J2540", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 100.98, "maximum": 217.3, "gross_charge": 255.65, "discounted_cash": 153.39, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 155.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 191.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 204.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 139.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 191.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 187.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 193.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 166.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 123.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 166.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 152.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 140.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 139.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 132.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 126.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 139.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 137.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 189.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 100.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 112.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 170.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 217.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 217.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 140.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 211.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 187.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 189.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 189.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 191.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 191.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 112.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 170.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 211.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 139.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 138.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 191.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 191.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 193.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 166.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 217.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 193.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 191.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 187.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 187.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 148.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 191.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 189.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 204.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 112.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 170.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 217.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 211.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 187.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 189.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 148.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 191.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 166.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 138.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 138.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 204.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 100.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION", "code_information": [{"code": "J2540", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 13.48, "maximum": 45.26, "gross_charge": 27.8, "discounted_cash": 16.68, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 26.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 29.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 45.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 29.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 45.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 29.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 45.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 26.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "J2540", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 23.76, "maximum": 40.23, "gross_charge": 27.8, "discounted_cash": 16.68, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 23.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 26.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 40.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 26.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 40.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 26.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 40.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 23.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PIPERACILLIN-TAZOBACTAM 40.5 GRAM INTRAVENOUS SOLUTION", "code_information": [{"code": "J2543", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 104.78, "maximum": 252.98, "gross_charge": 216.05, "discounted_cash": 129.63, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 158.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 160.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 160.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 162.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 160.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 135.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 158.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 158.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 158.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 160.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 125.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 165.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 252.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 183.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 183.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 118.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 178.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 117.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 111.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 115.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 117.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 159.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 150.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 140.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 158.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 163.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 140.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 162.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 117.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 162.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 172.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 162.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 172.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 135.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 117.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 117.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 162.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 140.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 165.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 252.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 183.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 178.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 162.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 163.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 163.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 140.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 165.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 252.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 178.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 183.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 162.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 162.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 117.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 117.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 172.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 160.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 162.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 125.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 162.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION", "code_information": [{"code": "J2543", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 11.25, "maximum": 24.78, "gross_charge": 29.15, "discounted_cash": 17.49, "payers_information": [{"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 13.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 21.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 13.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 21.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 13.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 21.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "J2543", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 16.03, "maximum": 18.95, "gross_charge": 29.15, "discounted_cash": 17.49, "payers_information": [{"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PIPERACILLIN-TAZOBACTAM IV SYRINGE 20 MG/ML (PEDIATRICS)", "code_information": [{"code": "J2543", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 5.04, "maximum": 14.05, "gross_charge": 10.4, "discounted_cash": 6.24, "payers_information": [{"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 14.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 14.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 14.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PIPERACILLIN-TAZOBACTAM IV SYRINGE 20 MG/ML (PEDIATRICS)|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "J2543", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.75, "maximum": 7.03, "gross_charge": 10.4, "discounted_cash": 6.24, "payers_information": [{"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PIPERACILLIN-TAZOBACTAM IVPB 20 MG/ML (PEDIATRICS)", "code_information": [{"code": "J2543", "type": "HCPCS"}], "drug_information": {"unit": 100, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 7.5, "maximum": 17.68, "gross_charge": 20.8, "discounted_cash": 12.48, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 14.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 14.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 14.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PIPERACILLIN-TAZOBACTAM IVPB 20 MG/ML (PEDIATRICS)|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "J2543", "type": "HCPCS"}], "drug_information": {"unit": 100, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 11.44, "maximum": 13.52, "gross_charge": 20.8, "discounted_cash": 12.48, "payers_information": [{"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PIPERACILLIN-TAZOBACTAM IVPB 20 MG/ML (NON-STANDARD) (PEDIATRICS)", "code_information": [{"code": "J2543", "type": "HCPCS"}], "drug_information": {"unit": 100, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.75, "maximum": 67.96, "gross_charge": 79.95, "discounted_cash": 47.97, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PIPERACILLIN-TAZOBACTAM IVPB 20 MG/ML (NON-STANDARD) (PEDIATRICS)|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "J2543", "type": "HCPCS"}], "drug_information": {"unit": 100, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 43.97, "maximum": 51.97, "gross_charge": 79.95, "discounted_cash": 47.97, "payers_information": [{"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PERAMIVIR (PF) 200 MG/20 ML (10 MG/ML) INTRAVENOUS SOLUTION", "code_information": [{"code": "J2547", "type": "HCPCS"}], "drug_information": {"unit": 20, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 335.6, "maximum": 1140.0, "gross_charge": 1425.0, "discounted_cash": 855.0, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1044.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1136.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 703.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 763.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 783.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 335.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 335.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 783.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 335.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1044.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 712.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 335.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1140.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 335.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1140.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1136.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 335.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 772.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1068.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1044.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1044.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1044.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 826.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1068.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 335.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 335.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 772.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 335.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1140.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 335.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 335.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 335.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 826.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PHENOBARBITAL IV SYRINGE 10 MG/ML (DILUTE) (PEDIATRICS)", "code_information": [{"code": "J2560", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 92.48, "maximum": 219.32, "gross_charge": 274.15, "discounted_cash": 164.49, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 92.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 135.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 146.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 150.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 150.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 200.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 219.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 92.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 200.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 137.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 219.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 148.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 205.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 200.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 200.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 200.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 159.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 205.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 148.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 219.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 159.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PHENOBARBITAL SODIUM 130 MG/ML INJECTION SOLUTION (PEDIATRICS)", "code_information": [{"code": "J2560", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 101.84, "maximum": 184.96, "gross_charge": 206.15, "discounted_cash": 123.69, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 119.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 164.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 111.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 154.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 151.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 119.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 151.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 151.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 154.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 111.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 164.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 184.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 164.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 184.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 151.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 113.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 113.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 110.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 151.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PHENOBARBITAL SODIUM 130 MG/ML INJECTION SOLUTION (PEDIATRICS)|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "J2560", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 92.48, "maximum": 92.48, "gross_charge": 206.15, "discounted_cash": 123.69, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 92.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 92.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PHENOBARBITAL SODIUM 130 MG/ML INJECTION SOLUTION", "code_information": [{"code": "J2560", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 101.84, "maximum": 184.96, "gross_charge": 206.15, "discounted_cash": 123.69, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 184.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 164.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 184.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 110.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 113.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 113.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 151.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 151.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 164.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 111.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 154.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 151.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 151.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 151.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 119.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 154.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 111.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 164.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 119.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PHENOBARBITAL SODIUM 130 MG/ML INJECTION SOLUTION|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "J2560", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 92.48, "maximum": 92.48, "gross_charge": 206.15, "discounted_cash": 123.69, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 92.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 92.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PHENOBARBITAL SODIUM 100 MG INTRAVENOUS SOLUTION", "code_information": [{"code": "J2561", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 117.6, "maximum": 486.68, "gross_charge": 608.35, "discounted_cash": 365.01, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 445.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 389.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 300.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 326.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 334.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 117.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 117.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 334.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 117.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 445.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 304.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 117.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 486.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 117.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 486.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 389.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 117.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 329.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 456.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 445.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 445.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 445.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 352.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 456.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 117.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 117.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 329.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 117.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 486.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 117.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 117.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 117.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 352.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PLERIXAFOR 24 MG/1.2 ML (20 MG/ML) SUBCUTANEOUS SOLUTION", "code_information": [{"code": "J2562", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 735.91, "maximum": 40246.1, "gross_charge": 47348.35, "discounted_cash": 28409.01, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34706.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 35179.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 35179.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 35511.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 35179.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 9691.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25852.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24479.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23390.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25378.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3112.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 4743.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 40246.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 40246.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 26041.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39109.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 735.91, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 735.91, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25852.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 30776.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 28172.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 26041.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 735.91, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34706.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1395.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35748.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30776.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22963.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 735.91, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35511.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25852.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35511.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37878.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 735.91, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28882.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37878.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 9691.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 735.91, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25662.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25662.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 35511.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30776.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34706.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34706.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34706.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 35179.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 27462.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3112.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 4743.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 40246.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39109.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35511.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35748.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40246.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35748.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30776.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3112.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 4743.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39109.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 35511.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 735.91, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 735.91, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35511.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25662.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25852.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 735.91, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37878.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 735.91, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 735.91, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 35179.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35511.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 735.91, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 27462.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35511.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OXYTOCIN 10 UNIT/ML INJECTION SOLUTION", "code_information": [{"code": "J2590", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 2.93, "maximum": 9.03, "gross_charge": 6.05, "discounted_cash": 3.63, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 9.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 9.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 9.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DESMOPRESSIN 4 MCG/ML SUBCUTANEOUS INJECTION", "code_information": [{"code": "J2597", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 52.6, "maximum": 103.4, "gross_charge": 121.65, "discounted_cash": 72.99, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 57.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 87.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 97.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 52.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 57.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 87.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 97.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 97.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 52.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 57.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 87.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DESMOPRESSIN 4 MCG/ML INJECTION SOLUTION", "code_information": [{"code": "J2597", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 52.6, "maximum": 103.4, "gross_charge": 121.65, "discounted_cash": 72.99, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 57.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 87.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 97.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 52.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 97.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 57.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 87.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 52.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 97.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 57.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 87.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "VASOPRESSIN 20 UNIT/ML INJECTION SOLUTION (SO)", "code_information": [{"code": "J2598", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 29.83, "maximum": 85.2, "gross_charge": 61.5, "discounted_cash": 36.9, "payers_information": [{"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 85.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 44.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 68.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 44.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 68.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 44.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 68.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 85.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "VASOPRESSIN 1 UNIT/ML INJECTION SOLUTION 50 ML (SIMPLE)", "code_information": [{"code": "J2598", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 112.1, "maximum": 259.25, "gross_charge": 305.0, "discounted_cash": 183.0, "payers_information": [{"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 226.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 244.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 166.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 165.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 176.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 228.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 226.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 213.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 223.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 226.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 226.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 228.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 163.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 198.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 181.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 167.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 170.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 259.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 259.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 167.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 251.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 228.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 228.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 228.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 112.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 170.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 251.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 230.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 198.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 259.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 230.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 228.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 223.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 223.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 226.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 176.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 112.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 170.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 259.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 251.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 223.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 166.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 228.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 198.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 165.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 165.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 186.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 244.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 213.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 228.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 244.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 228.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 152.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 230.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 198.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 147.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 223.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 166.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 112.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 166.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 157.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 150.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PROCAINAMIDE 500 MG/ML INJECTION SOLUTION", "code_information": [{"code": "J2690", "type": "HCPCS"}], "drug_information": {"unit": 2, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 344.53, "maximum": 2221.18, "gross_charge": 1625.35, "discounted_cash": 975.21, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1191.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 1207.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1207.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 1219.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1207.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 656.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 887.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 840.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 802.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 871.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1457.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 2221.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1381.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 1381.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 893.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1342.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 344.53, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 344.53, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 887.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 1202.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1129.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 1056.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 344.53, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1191.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 812.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1227.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1056.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 788.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 344.53, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1219.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 887.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1219.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1300.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 344.53, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1219.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1300.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 656.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 344.53, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 880.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 880.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1219.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1056.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1191.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1191.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1191.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1207.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 942.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1457.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 2221.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 1381.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1342.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1219.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1227.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1381.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1227.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1056.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1457.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 2221.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1342.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1219.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 344.53, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 344.53, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1219.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 880.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 887.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 344.53, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1300.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 344.53, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 344.53, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1207.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1219.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 344.53, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 942.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1219.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OXACILLIN IV SYRINGE 50 MG/ML (PEDIATRICS)", "code_information": [{"code": "J2700", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 24.11, "maximum": 76.8, "gross_charge": 90.35, "discounted_cash": 54.21, "payers_information": [{"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 27.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 24.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 36.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 27.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 24.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 36.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 24.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 36.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OXACILLIN 1 GRAM SOLUTION FOR INJECTION", "code_information": [{"code": "J2700", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 9.64, "maximum": 20.36, "gross_charge": 23.95, "discounted_cash": 14.37, "payers_information": [{"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 9.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 14.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 9.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 14.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 9.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 14.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OXACILLIN 10 GRAM SOLUTION FOR INJECTION", "code_information": [{"code": "J2700", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 73.94, "maximum": 146.99, "gross_charge": 152.45, "discounted_cash": 91.47, "payers_information": [{"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 115.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 121.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 121.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 110.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 111.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 113.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 88.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 96.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 146.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 129.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 125.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 111.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 111.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 115.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 96.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 146.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 125.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 96.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 146.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 129.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 129.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 125.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 111.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 111.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 113.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 113.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 113.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 110.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 115.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 129.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 121.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 113.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 88.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PROPOFOL 10 MG/ML INTRAVENOUS EMULSION", "code_information": [{"code": "J2704", "type": "HCPCS"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.0, "maximum": 58.02, "gross_charge": 6.45, "discounted_cash": 3.87, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PROPOFOL 10 MG/ML INTRAVENOUS EMULSION", "code_information": [{"code": "J2704", "type": "HCPCS"}], "drug_information": {"unit": 100, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.0, "maximum": 58.02, "gross_charge": 57.5, "discounted_cash": 34.5, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 30.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 38.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 58.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 30.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 38.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 58.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 38.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 58.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PROPOFOL 10 MG/ML INTRAVENOUS EMULSION", "code_information": [{"code": "J2704", "type": "HCPCS"}], "drug_information": {"unit": 20, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.0, "maximum": 58.02, "gross_charge": 11.5, "discounted_cash": 6.9, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 11.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 11.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 11.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PROPOFOL 10 MG/ML INTRAVENOUS EMULSION", "code_information": [{"code": "J2704", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.0, "maximum": 58.02, "gross_charge": 28.75, "discounted_cash": 17.25, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 15.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 19.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 29.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 15.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 19.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 29.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 19.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 29.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PROPOFOL 10 MG/ML INFUSION", "code_information": [{"code": "J2704", "type": "HCPCS"}], "drug_information": {"unit": 100, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 13.94, "maximum": 58.02, "gross_charge": 57.5, "discounted_cash": 34.5, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 30.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 38.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 58.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 38.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 58.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 38.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 58.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 30.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PROPOFOL 10 MG/ML INFUSION", "code_information": [{"code": "J2704", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 13.94, "maximum": 58.02, "gross_charge": 28.75, "discounted_cash": 17.25, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 15.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 19.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 29.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 19.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 29.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 19.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 29.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 15.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "NEOSTIGMINE METHYLSULFATE 3 MG/3 ML (1 MG/ML) INTRAVENOUS SYRINGE", "code_information": [{"code": "J2710", "type": "HCPCS"}], "drug_information": {"unit": 3, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 17.77, "maximum": 38.89, "gross_charge": 45.75, "discounted_cash": 27.45, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 32.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 17.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 27.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 32.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 17.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 27.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 17.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 27.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "NEOSTIGMINE METHYLSULFATE 1 MG/ML INJECTION SOLUTION (SO)", "code_information": [{"code": "J2710", "type": "HCPCS"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 5.55, "maximum": 107.4, "gross_charge": 11.45, "discounted_cash": 6.87, "payers_information": [{"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 59.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 90.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 107.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 59.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 90.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 107.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 59.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 90.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PROTAMINE 10 MG/ML INTRAVENOUS SOLUTION", "code_information": [{"code": "J2720", "type": "HCPCS"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 27.7, "maximum": 52.96, "gross_charge": 62.3, "discounted_cash": 37.38, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 27.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 33.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 50.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 27.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 33.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 50.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 33.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 50.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PROTEIN C CONCENTRATE, HUMAN 500 UNIT INTRAVENOUS SOLUTION", "code_information": [{"code": "J2724", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 15.01, "maximum": 54.0, "gross_charge": 67.5, "discounted_cash": 40.5, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 50.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 15.01, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 15.01, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 15.01, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 15.01, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 15.01, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 50.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 15.01, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 15.01, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 15.01, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 15.01, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 15.01, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 15.01, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 15.01, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PRALIDOXIME 1 GRAM SOLUTION FOR INJECTION", "code_information": [{"code": "J2730", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 351.66, "maximum": 1712.24, "gross_charge": 2140.3, "discounted_cash": 1284.18, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 351.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1712.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 351.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1241.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1241.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PHENTOLAMINE 5 MG INJECTION SOLUTION FOR IV/IM", "code_information": [{"code": "J2760", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 420.56, "maximum": 2711.35, "gross_charge": 1915.3, "discounted_cash": 1149.18, "payers_information": [{"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1436.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1403.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 1423.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1423.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 1436.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1423.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1475.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1045.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 990.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 946.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1026.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1778.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 2711.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1628.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 1628.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1053.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1582.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 420.56, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 420.56, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 1244.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1139.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 1053.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1045.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 420.56, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1403.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 957.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1446.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1244.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 928.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 420.56, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1436.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1436.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1532.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1045.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 420.56, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1168.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1532.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1475.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1038.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1038.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1436.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1244.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 420.56, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1403.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1778.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 2711.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 1628.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1582.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1403.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1423.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1110.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1403.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1436.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1446.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1628.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1446.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1244.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1778.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 2711.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1582.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1436.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 420.56, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 420.56, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1436.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1038.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1045.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 420.56, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1532.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 420.56, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 420.56, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1423.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1436.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 420.56, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1110.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PHENTOLAMINE 5 MG INJECTION SOLUTION FOR SUBCUTANEOUS", "code_information": [{"code": "J2760", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 420.56, "maximum": 2711.35, "gross_charge": 1915.3, "discounted_cash": 1149.18, "payers_information": [{"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1436.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1403.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 1423.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1423.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 1436.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1026.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1045.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 990.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 946.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1423.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1475.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 1244.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1139.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 1053.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 420.56, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 420.56, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1778.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 2711.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1628.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 1628.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1053.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1582.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1038.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1038.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1168.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1532.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1475.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 420.56, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1045.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1436.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1532.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1436.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 420.56, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1446.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1244.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 928.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 957.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1403.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 420.56, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1045.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1110.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 420.56, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1436.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1423.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 420.56, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 420.56, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1532.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 420.56, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1045.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1038.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1436.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 420.56, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 420.56, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1436.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1778.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 2711.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1582.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1446.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1244.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1628.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1446.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1436.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1403.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1403.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1423.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1110.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1778.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 2711.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 1628.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1582.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1403.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 420.56, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1436.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1244.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "METOCLOPRAMIDE IV SYRINGE 0.5 MG/ML (PEDIATRICS)", "code_information": [{"code": "J2765", "type": "HCPCS"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.38, "maximum": 55.04, "gross_charge": 64.75, "discounted_cash": 38.85, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "RASBURICASE 1.5 MG INTRAVENOUS SOLUTION", "code_information": [{"code": "J2783", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1150.12, "maximum": 7414.76, "gross_charge": 5192.5, "discounted_cash": 3115.5, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3806.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 3858.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3858.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 3894.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3858.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3817.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2835.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2684.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2565.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2783.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4864.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 7414.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4413.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4413.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2855.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4289.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1150.12, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1150.12, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2835.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 3375.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 2855.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 2855.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1150.12, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3806.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1418.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3920.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3375.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2518.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1150.12, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3894.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2835.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3894.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4154.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1150.12, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3167.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4154.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3817.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1150.12, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2814.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2814.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3894.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3375.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3806.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3806.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3806.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3858.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3011.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4864.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 7414.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4413.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4289.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3894.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3920.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4413.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3920.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3375.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4864.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 7414.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4289.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3894.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1150.12, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1150.12, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3894.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2814.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2835.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1150.12, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4154.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1150.12, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1150.12, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3858.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3894.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1150.12, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3011.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3894.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "RIBOFLAV 0.146% EYE DROPS-RIBOFLAV 0.146% IN 20% DEXTRAN VISC EYE DROP", "code_information": [{"code": "J2787", "type": "HCPCS"}], "drug_information": {"unit": 6, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 2012.75, "maximum": 29398.32, "gross_charge": 4150.0, "discounted_cash": 2490.0, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3041.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 3083.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3083.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 3112.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3083.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 18495.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2265.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2145.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2050.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2224.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 19288.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 29398.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 3527.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 3527.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2282.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3427.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2265.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 3071.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 2884.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 2697.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3041.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2075.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3133.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2697.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2012.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3112.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2265.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3112.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3320.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3112.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3320.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 18495.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2249.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2249.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3112.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2697.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3041.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3041.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3041.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3083.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2407.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 19288.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 29398.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 3527.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3427.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3112.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3133.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3527.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3133.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2697.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 19288.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 29398.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3427.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3112.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3112.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2249.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2265.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3320.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3083.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3112.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2407.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3112.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJECTION SOLUTION", "code_information": [{"code": "J2795", "type": "HCPCS"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 4.0, "maximum": 15.94, "gross_charge": 18.75, "discounted_cash": 11.25, "payers_information": [{"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJECTION SOLUTION", "code_information": [{"code": "J2795", "type": "HCPCS"}], "drug_information": {"unit": 30, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 13.82, "maximum": 48.35, "gross_charge": 28.5, "discounted_cash": 17.1, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 31.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 48.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 30.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 31.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 48.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 30.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 31.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 48.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ROPIVACAINE (PF) 0.2 % 100 ML EPIDURAL (PEDIATRIC)", "code_information": [{"code": "J2795", "type": "HCPCS"}], "drug_information": {"unit": 100, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 40.0, "maximum": 111.44, "gross_charge": 131.1, "discounted_cash": 78.66, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 96.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 97.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 97.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 42.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 64.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 111.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 97.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 97.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 40.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 42.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 64.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 111.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 111.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 97.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 96.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 40.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 96.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 96.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 96.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 97.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 42.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 64.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 111.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ROPIVACAINE (PF) 0.2 % 100 ML REGIONAL (PEDIATRIC)", "code_information": [{"code": "J2795", "type": "HCPCS"}], "drug_information": {"unit": 100, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 40.0, "maximum": 111.44, "gross_charge": 131.1, "discounted_cash": 78.66, "payers_information": [{"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 42.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 64.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 111.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 96.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 97.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 96.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 96.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 40.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 96.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 97.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 42.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 64.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 111.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 111.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 97.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 40.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 97.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 111.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 42.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 64.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 96.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 97.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 97.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ROMIPLOSTIM 500 MCG/ML VIAL", "code_information": [{"code": "J2796", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 2226.54, "maximum": 10398.69, "gross_charge": 12233.75, "discounted_cash": 7340.25, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8967.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 9089.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 9089.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 9175.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 9089.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6116.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6679.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6324.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6043.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6557.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7450.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8025.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 10398.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 10398.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 6728.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10105.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2520.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2226.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6679.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 9052.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 8502.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 7951.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8967.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6921.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9236.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7951.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5933.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9175.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6679.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9175.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9787.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9175.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9787.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6116.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2862.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6630.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6630.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 9175.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7951.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8967.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8967.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8967.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 9089.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 7095.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7450.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8025.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 10398.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10105.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9175.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9236.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10398.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9236.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7951.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7450.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8025.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10105.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 9175.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2862.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2862.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9175.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6630.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6679.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2862.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9787.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 9089.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9175.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 7095.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9175.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "METHOCARBAMOL 100 MG/ML INJECTION SOLUTION", "code_information": [{"code": "J2800", "type": "HCPCS"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 16.19, "maximum": 50.07, "gross_charge": 58.9, "discounted_cash": 35.34, "payers_information": [{"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 19.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 29.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 16.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 19.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 29.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 16.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 19.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 29.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ROMIPLOSTIM 250 MCG SUBCUTANEOUS SOLUTION", "code_information": [{"code": "J2802", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 2762.0, "maximum": 17809.84, "gross_charge": 12233.75, "discounted_cash": 7340.25, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8967.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 9089.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 9089.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 9175.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 9089.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 9295.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6679.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6324.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6043.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6557.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11685.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 17809.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 10398.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 10398.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 6728.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10105.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2762.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2762.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6679.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 9052.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 8502.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 7951.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2762.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8967.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3462.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9236.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7951.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5933.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2762.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9175.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6679.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9175.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9787.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2762.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9175.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9787.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 9295.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2762.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6630.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6630.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 9175.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7951.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8967.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8967.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8967.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 9089.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 7095.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11685.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 17809.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 10398.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10105.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9175.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9236.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10398.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9236.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7951.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11685.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 17809.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10105.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 9175.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2762.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2762.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9175.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6630.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6679.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2762.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9787.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2762.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2762.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 9089.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9175.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2762.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 7095.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9175.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "RIFAMPIN 600 MG INTRAVENOUS SOLUTION", "code_information": [{"code": "J2804", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 180.52, "maximum": 580.23, "gross_charge": 372.2, "discounted_cash": 223.32, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 272.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 276.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 276.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 279.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 276.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 324.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 203.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 192.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 183.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 199.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 380.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 580.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 316.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 316.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 204.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 307.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 203.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 241.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 204.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 204.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 272.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 186.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 281.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 241.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 180.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 279.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 203.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 279.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 297.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 297.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 324.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 201.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 201.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 279.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 241.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 272.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 272.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 272.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 276.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 215.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 380.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 580.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 316.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 307.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 279.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 281.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 316.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 281.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 241.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 380.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 580.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 307.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 279.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 279.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 201.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 203.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 297.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 276.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 279.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 215.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 279.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SINCALIDE 5 MCG SOLUTION FOR INJECTION", "code_information": [{"code": "J2805", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 168.68, "maximum": 710.01, "gross_charge": 347.8, "discounted_cash": 208.68, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 254.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 258.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 258.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 260.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 258.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 459.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 189.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 179.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 171.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 186.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 465.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 710.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 295.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 295.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 191.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 287.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 189.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 226.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 191.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 191.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 188.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 188.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 260.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 226.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 254.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 254.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 254.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 258.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 201.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 465.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 710.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 295.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 287.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 260.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 262.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 295.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 262.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 226.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 465.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 710.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 287.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 260.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 260.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 188.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 189.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 278.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 258.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 260.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 201.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 260.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 254.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 173.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 262.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 226.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 168.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 260.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 189.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 260.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 278.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 278.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 459.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SINCALIDE 5 MCG SOLUTION FOR INJECTION|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "J2805", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 226.07, "maximum": 260.85, "gross_charge": 347.8, "discounted_cash": 208.68, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 260.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 257.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 241.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 226.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SARGRAMOSTIM 250 MCG SOLUTION FOR INJECTION", "code_information": [{"code": "J2820", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 308.73, "maximum": 1990.51, "gross_charge": 1370.2, "discounted_cash": 822.12, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1004.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 1018.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1018.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 1027.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1018.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 947.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 748.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 708.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 676.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 734.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1306.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1990.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1164.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 1164.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 753.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1131.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 308.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 308.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 748.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 890.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 815.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 753.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 308.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1004.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 407.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1034.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 890.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 664.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 308.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1027.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 748.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1027.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1096.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 308.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 835.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1096.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 947.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 308.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 742.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 742.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1027.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 890.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1004.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1004.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1004.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1018.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 794.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1306.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1990.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 1164.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1131.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1027.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1034.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1164.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1034.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 890.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1306.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1990.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1131.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1027.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 308.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 308.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1027.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 742.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 748.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 308.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1096.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 308.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 308.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1018.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1027.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 308.73, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 794.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1027.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SECRETIN (HUMAN) 16 MCG INTRAVENOUS SOLUTION", "code_information": [{"code": "J2850", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 647.02, "maximum": 4261.21, "gross_charge": 2974.5, "discounted_cash": 1784.7, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2180.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 2210.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2210.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 2230.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2210.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2368.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1624.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1537.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1469.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1594.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2795.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 4261.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 2528.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 2528.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1635.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2456.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 647.02, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 647.02, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1624.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 1933.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1635.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 1635.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 647.02, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2180.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1487.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2245.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1933.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1442.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 647.02, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2230.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1624.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2230.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2379.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 647.02, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2379.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2368.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 647.02, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1612.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1612.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2230.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1933.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2180.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2180.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2180.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2210.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1725.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2795.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 4261.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 2528.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2456.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2230.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2245.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2528.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2245.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1933.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2795.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 4261.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2456.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2230.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 647.02, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 647.02, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2230.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1612.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1624.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 647.02, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2379.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 647.02, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 647.02, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2210.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2230.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 647.02, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1725.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2230.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SULFAMETHOXAZOLE-TRIMETHOPRIM IV SYRINGE 16 MG/ML (PEDIATRICS) - CENTRAL LINE ONLY", "code_information": [{"code": "J2865", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 135.36, "maximum": 316.88, "gross_charge": 372.8, "discounted_cash": 223.68, "payers_information": [{"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 276.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 279.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 216.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 279.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 135.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 206.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 307.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 316.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 279.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 279.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 202.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 203.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 298.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 202.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 202.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 279.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 242.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 273.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 273.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 273.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 276.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 216.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 135.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 206.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 316.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 307.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 279.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 281.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 281.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 242.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 276.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 136.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 135.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 206.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 316.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 316.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 205.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 307.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 273.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 276.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 276.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 279.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 203.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 192.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 184.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 199.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 203.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 242.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 221.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 205.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 273.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 186.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 281.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 242.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 180.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 279.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 203.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 279.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 298.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 227.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 298.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 136.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SULFAMETHOXAZOLE-TRIMETHOPRIM IV SYRINGE 0.8 MG/ML (PEDIATRICS)", "code_information": [{"code": "J2865", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 6.77, "maximum": 20.49, "gross_charge": 24.1, "discounted_cash": 14.46, "payers_information": [{"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SULFAMETHOXAZOLE 400 MG-TRIMETHOPRIM 80 MG/5 ML INTRAVENOUS SOLUTION", "code_information": [{"code": "J2865", "type": "HCPCS"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 13.54, "maximum": 41.26, "gross_charge": 37.45, "discounted_cash": 22.47, "payers_information": [{"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 27.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 41.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 27.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 41.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 27.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 27.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 41.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 27.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SULFAMETHOXAZOLE 400 MG-TRIMETHOPRIM 80 MG/5 ML INTRAVENOUS SOLUTION", "code_information": [{"code": "J2865", "type": "HCPCS"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 13.54, "maximum": 41.26, "gross_charge": 37.3, "discounted_cash": 22.38, "payers_information": [{"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 20.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 20.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 20.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML (ELEMENTAL IRON) INTRAVENOUS", "code_information": [{"code": "J2916", "type": "HCPCS"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 25.05, "maximum": 71.24, "gross_charge": 51.65, "discounted_cash": 30.99, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 46.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 71.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 46.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 71.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 46.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 71.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION", "code_information": [{"code": "J2919", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 32.35, "maximum": 335.24, "gross_charge": 66.7, "discounted_cash": 40.02, "payers_information": [{"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 176.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 219.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 335.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 219.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 335.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 176.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 219.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 335.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "METHYLPREDNISOLONE SOD SUCC (PF) 40 MG/ML SOLUTION FOR INJECTION", "code_information": [{"code": "J2919", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 7.04, "maximum": 24.86, "gross_charge": 29.25, "discounted_cash": 17.55, "payers_information": [{"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 13.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 13.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 13.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION", "code_information": [{"code": "J2919", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 22.0, "maximum": 41.91, "gross_charge": 46.55, "discounted_cash": 27.93, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 22.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 27.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 41.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 27.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 41.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 27.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 41.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 22.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "METHYLPREDNISOLONE SOD SUCC (PF) 1,000 MG/8 ML INTRAVENOUS SOLUTION", "code_information": [{"code": "J2919", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 149.28, "maximum": 335.24, "gross_charge": 307.8, "discounted_cash": 184.68, "payers_information": [{"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 153.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 225.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 227.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 213.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 200.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 230.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 246.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 176.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 230.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 246.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 168.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 230.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 232.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 200.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 149.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 246.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 168.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 166.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 230.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 230.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 261.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 219.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 335.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 254.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 232.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 200.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 232.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 230.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 219.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 335.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 261.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 254.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 225.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 228.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 178.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 225.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 225.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 230.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 200.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 166.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 166.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 230.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 178.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 230.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 228.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 168.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 164.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 168.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 159.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 152.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 219.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 335.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 261.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 261.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 169.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 254.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 228.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 176.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 225.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 228.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 228.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 230.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "METHYLPREDNISOLONE SOD SUCC IV SYRINGE 4 MG/ML (PEDIATRICS)", "code_information": [{"code": "J2919", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 35.2, "maximum": 119.34, "gross_charge": 140.4, "discounted_cash": 84.24, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 35.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 43.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 67.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 119.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 119.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 115.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 43.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 67.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 115.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 119.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 43.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 67.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 119.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 115.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 35.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 97.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "METHYLPREDNISOLONE SOD SUCC INFUSION 62.5 MG/ML", "code_information": [{"code": "J2919", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 360.94, "maximum": 1047.64, "gross_charge": 744.2, "discounted_cash": 446.52, "payers_information": [{"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 406.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 398.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 406.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 384.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 367.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 687.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1047.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 632.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 632.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 409.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 614.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 545.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 552.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 552.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 558.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 552.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 550.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 558.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 431.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 558.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 552.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 595.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 406.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 403.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 558.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 558.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 632.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 687.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1047.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 614.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 561.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 483.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 561.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 558.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 687.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1047.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 632.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 614.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 545.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 552.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 431.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 545.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 545.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 558.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 483.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 403.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 403.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 372.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 545.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 550.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 517.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 483.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 558.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 595.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 550.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 558.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 595.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 406.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 558.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 561.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 483.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 360.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "METHYLPREDNISOLONE SOD SUCC IV SYRINGE 62.5 MG/ML (PEDIATRICS)", "code_information": [{"code": "J2919", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 304.46, "maximum": 1047.64, "gross_charge": 627.75, "discounted_cash": 376.65, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 466.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 550.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 460.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 466.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 466.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 470.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 687.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1047.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 533.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 533.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 345.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 518.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 342.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 310.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 336.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 342.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 473.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 408.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 304.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 470.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 342.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 470.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 502.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 470.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 502.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 550.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 464.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 436.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 408.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 460.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 313.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 687.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1047.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 518.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 533.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 470.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 470.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 340.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 342.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 502.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 340.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 340.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 470.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 408.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 460.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 460.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 460.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 466.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 364.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 687.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1047.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 533.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 518.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 470.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 473.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 473.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 408.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 466.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 470.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 364.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 470.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "METHYLPREDNISOLONE SOD SUCC INFUSION 62.5 MG/ML FOR SPINAL CORD (PEDIATRICS)", "code_information": [{"code": "J2919", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 395.81, "maximum": 1047.64, "gross_charge": 816.1, "discounted_cash": 489.66, "payers_information": [{"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 652.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 445.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 442.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 612.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 612.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 693.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 687.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1047.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 674.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 616.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 530.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 616.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 612.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 687.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1047.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 693.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 674.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 598.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 606.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 473.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 598.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 598.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 612.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 530.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 442.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 442.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 408.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 598.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 603.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 567.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 530.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 612.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 652.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 550.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 612.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 652.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 445.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 612.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 616.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 530.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 395.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 612.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 473.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 612.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 606.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 445.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 437.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 445.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 421.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 403.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 687.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1047.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 693.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 693.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 448.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 674.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 598.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 606.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 606.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 612.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 606.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 550.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION (PEDIATRICS)", "code_information": [{"code": "J2919", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 22.0, "maximum": 41.91, "gross_charge": 46.55, "discounted_cash": 27.93, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 22.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 27.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 41.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 22.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 27.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 41.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 27.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 41.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SOMATROPIN 15 MG/1.5 ML (10 MG/ML) SUBCUTANEOUS PEN INJECTOR", "code_information": [{"code": "J2941", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 1893.77, "maximum": 8324.28, "gross_charge": 10405.35, "discounted_cash": 6243.21, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7627.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2480.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5140.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5577.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5722.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2143.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1893.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 5722.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7627.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5202.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8324.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8324.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2480.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2434.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5639.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 7804.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7627.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7627.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7627.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6035.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 7804.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2434.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2434.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5639.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2434.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8324.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6035.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ALTEPLASE SYRINGE 1 MG/ML (FROM 50 MG VIAL)", "code_information": [{"code": "J2997", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 93.83, "maximum": 604.92, "gross_charge": 467.1, "discounted_cash": 280.26, "payers_information": [{"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 93.83, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 233.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 93.83, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 350.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 255.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 350.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 373.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 93.83, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 350.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 373.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 318.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 93.83, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 93.83, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 255.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 345.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 303.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 93.83, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 342.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 352.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 303.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 226.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 350.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 347.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 350.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 93.83, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 270.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 93.83, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 350.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 253.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 255.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 93.83, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 373.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 93.83, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 93.83, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 347.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 318.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 255.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 241.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 230.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 396.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 604.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 397.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 397.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 256.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 385.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 253.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 253.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 350.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 303.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 250.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 342.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 396.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 604.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 397.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 385.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 342.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 347.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 270.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 342.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 350.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 352.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 397.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 352.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 303.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 396.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 604.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 385.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 350.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 93.83, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 342.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 347.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 347.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 350.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ALTEPLASE INFUSION 1 MG/ML (PEDIATRICS)", "code_information": [{"code": "J2997", "type": "HCPCS"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 281.5, "maximum": 30246.1, "gross_charge": 3716.65, "discounted_cash": 2229.99, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2724.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 2761.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2761.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 2787.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2029.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1921.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1836.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2761.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3182.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2724.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1992.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2787.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2415.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2014.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2014.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3969.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 6049.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 3159.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 3159.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2044.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3069.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 938.32, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2787.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3969.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 6049.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3069.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2806.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2415.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3159.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2806.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2787.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2724.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2724.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2761.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2155.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3969.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 6049.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 3159.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3069.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 938.32, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 938.32, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2973.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 938.32, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2029.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2014.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2787.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 938.32, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2155.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 938.32, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2787.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2761.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2787.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2806.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2415.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1802.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2724.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 938.32, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 2750.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 2583.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 2415.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2029.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 938.32, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 938.32, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2787.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2973.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3182.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 938.32, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2787.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2973.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2029.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2787.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 938.32, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1858.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 938.32, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ALTEPLASE INFUSION 1 MG/ML (PEDIATRICS)", "code_information": [{"code": "J2997", "type": "HCPCS"}], "drug_information": {"unit": 20, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 281.5, "maximum": 30246.1, "gross_charge": 7433.25, "discounted_cash": 4459.95, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5448.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 5522.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5522.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 5574.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4058.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3842.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3672.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5522.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6364.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5448.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3984.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 5574.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4831.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4028.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4028.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7938.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 12098.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 6318.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 6318.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4088.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6139.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1876.64, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 5574.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7938.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 12098.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6139.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5612.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4831.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6318.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5612.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5574.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5448.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5448.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5522.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4311.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7938.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 12098.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 6318.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6139.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1876.64, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1876.64, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5946.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1876.64, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4058.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4028.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5574.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1876.64, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4311.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1876.64, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5574.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5522.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5574.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5612.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4831.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3605.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5448.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1876.64, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 5500.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 5166.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 4831.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4058.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1876.64, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1876.64, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5574.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5946.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6364.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1876.64, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5574.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5946.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4058.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5574.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1876.64, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3716.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1876.64, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ALTEPLASE INFUSION 1 MG/ML (PEDIATRICS)", "code_information": [{"code": "J2997", "type": "HCPCS"}], "drug_information": {"unit": 3, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 281.5, "maximum": 30246.1, "gross_charge": 1238.9, "discounted_cash": 743.34, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 908.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 920.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 920.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 929.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 676.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 640.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 612.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 920.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 954.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 908.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 664.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 929.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 805.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 671.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 671.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1190.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 281.5, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 929.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1190.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1814.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1023.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 935.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 805.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1053.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 935.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 929.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 908.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 908.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 920.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 718.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1190.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1814.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 1053.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1023.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 281.5, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 281.5, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 991.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 281.5, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 676.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 671.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 929.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 281.5, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 718.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 281.5, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 929.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 920.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 929.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 935.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 805.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 600.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 908.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 281.5, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 916.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 861.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 805.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 676.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 281.5, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 281.5, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1814.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1053.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 1053.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 681.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1023.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 281.5, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 929.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 991.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 676.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 929.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 281.5, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 619.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 281.5, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 929.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 991.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 954.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ALTEPLASE INFUSION 1 MG/ML (PEDIATRICS)", "code_information": [{"code": "J2997", "type": "HCPCS"}], "drug_information": {"unit": 30, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 281.5, "maximum": 30246.1, "gross_charge": 11149.85, "discounted_cash": 6689.91, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8172.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 8284.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 8284.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 8362.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6087.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5764.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5508.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 8284.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 9546.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8172.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5976.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 8362.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7247.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6043.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6043.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2814.96, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 8362.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11907.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 18147.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9209.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8418.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7247.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9477.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8418.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8362.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8172.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8172.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 8284.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6466.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11907.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 18147.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 9477.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9209.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2814.96, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2814.96, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8919.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2814.96, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6087.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6043.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8362.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2814.96, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6466.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2814.96, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8362.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 8284.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8362.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8418.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7247.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5407.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8172.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2814.96, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 8250.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 7749.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 7247.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6087.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2814.96, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2814.96, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11907.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 18147.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 9477.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 9477.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 6132.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9209.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2814.96, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8362.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8919.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6087.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8362.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2814.96, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5574.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2814.96, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8362.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8919.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 9546.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ALTEPLASE INFUSION 1 MG/ML (PEDIATRICS)", "code_information": [{"code": "J2997", "type": "HCPCS"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 281.5, "maximum": 30246.1, "gross_charge": 1858.35, "discounted_cash": 1115.01, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1362.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 1380.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1380.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 1393.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1014.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 960.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 918.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1380.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1591.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1362.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 996.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1393.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1207.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1007.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1007.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 469.16, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1393.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1984.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 3024.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1535.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1403.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1207.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1579.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1403.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1393.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1362.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1362.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1380.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1077.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1984.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 3024.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 1579.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1535.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 469.16, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 469.16, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1486.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 469.16, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1014.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1007.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1393.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 469.16, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1077.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 469.16, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1393.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1380.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1393.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1403.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1207.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 901.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1362.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 469.16, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 1375.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1291.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 1207.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1014.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 469.16, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 469.16, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1984.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 3024.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1579.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 1579.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1022.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1535.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 469.16, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1393.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1486.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1014.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1393.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 469.16, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 929.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 469.16, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1393.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1486.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1591.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ALTEPLASE INFUSION 1 MG/ML (PEDIATRICS)", "code_information": [{"code": "J2997", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 281.5, "maximum": 30246.1, "gross_charge": 18583.1, "discounted_cash": 11149.86, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13621.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 13807.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 13807.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 13937.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10146.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9607.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9180.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 13807.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 15911.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13621.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9960.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 13937.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12079.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10072.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10072.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 4691.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 13937.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 19845.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 30246.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15349.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14030.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12079.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15795.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14030.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13937.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13621.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13621.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 13807.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 10778.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 19845.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 30246.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 15795.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15349.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 4691.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 4691.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14866.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 4691.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10146.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10072.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13937.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 4691.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 10778.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 4691.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13937.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 13807.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13937.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14030.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12079.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9012.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13621.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 4691.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 13751.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 12915.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 12079.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10146.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 4691.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 4691.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 19845.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 30246.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 15795.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 15795.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10220.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15349.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 4691.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13937.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14866.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10146.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13937.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 4691.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9291.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 4691.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13937.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14866.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 15911.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ALTEPLASE INFUSION 1 MG/ML (PEDIATRICS)|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "J2997", "type": "HCPCS"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 681.4, "maximum": 12079.02, "gross_charge": 1858.35, "discounted_cash": 1115.01, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1133.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 1207.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1105.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 1022.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ALTEPLASE INFUSION 1 MG/ML (PEDIATRICS)|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "J2997", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 681.4, "maximum": 12079.02, "gross_charge": 18583.1, "discounted_cash": 11149.86, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11335.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 12079.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 11056.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 10220.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ALTEPLASE INFUSION 1 MG/ML (PEDIATRICS)|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "J2997", "type": "HCPCS"}], "drug_information": {"unit": 30, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 681.4, "maximum": 12079.02, "gross_charge": 11149.85, "discounted_cash": 6689.91, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6801.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 7247.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 6634.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 6132.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ALTEPLASE INFUSION 1 MG/ML (PEDIATRICS)|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "J2997", "type": "HCPCS"}], "drug_information": {"unit": 3, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 681.4, "maximum": 12079.02, "gross_charge": 1238.9, "discounted_cash": 743.34, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 755.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 805.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 737.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 681.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ALTEPLASE INFUSION 1 MG/ML (PEDIATRICS)|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "J2997", "type": "HCPCS"}], "drug_information": {"unit": 20, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 681.4, "maximum": 12079.02, "gross_charge": 7433.25, "discounted_cash": 4459.95, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4534.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 4831.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4422.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 4088.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ALTEPLASE INFUSION 1 MG/ML (PEDIATRICS)|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "J2997", "type": "HCPCS"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 681.4, "maximum": 12079.02, "gross_charge": 3716.65, "discounted_cash": 2229.99, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2267.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 2415.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 2211.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 2044.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ALTEPLASE 1 MG/ML IV SYRINGE (PEDIATRICS)", "code_information": [{"code": "J2997", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 4691.6, "maximum": 30246.1, "gross_charge": 23354.1, "discounted_cash": 14012.46, "payers_information": [{"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17515.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 17352.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17515.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 4691.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 13545.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 4691.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17515.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12657.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12751.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 4691.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18683.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 4691.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 4691.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 17352.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 15911.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12751.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12074.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11536.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12657.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12657.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 17515.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15180.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12517.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17118.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 19845.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 30246.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 19850.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19290.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17118.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 17352.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 13545.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17118.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17515.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17632.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19850.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17632.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15180.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 19845.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 30246.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19290.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 17515.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 4691.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17118.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 17352.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 17352.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 17515.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 4691.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17515.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18683.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 15911.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 4691.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17515.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18683.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11677.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 4691.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17515.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12751.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 17282.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 16231.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 15180.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 4691.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17118.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17632.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15180.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11326.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12751.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 4691.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 4691.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 19845.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 30246.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 19850.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 19850.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 12844.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19290.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ALTEPLASE 1 MG/ML IV SYRINGE (PEDIATRICS)|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "J2997", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 12844.76, "maximum": 15180.17, "gross_charge": 23354.1, "discounted_cash": 14012.46, "payers_information": [{"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 15180.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 13895.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 12844.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14246.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ALTEPLASE INHALATION 1 MG/ML (PEDIATRICS)", "code_information": [{"code": "J2997", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 187.66, "maximum": 759.43, "gross_charge": 893.45, "discounted_cash": 536.07, "payers_information": [{"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 661.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 620.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 580.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 674.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 580.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 433.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 705.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 187.66, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 544.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 586.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 759.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 759.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 491.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 737.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 187.66, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 187.66, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 487.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 670.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 714.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 637.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 187.66, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 487.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 670.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 187.66, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 625.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 670.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 714.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 187.66, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 487.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 461.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 441.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 663.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 637.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 705.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 665.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 670.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 580.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 484.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 484.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 187.66, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 670.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 544.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 586.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 737.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 674.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 580.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 759.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 674.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 670.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 705.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 705.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 663.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 518.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 544.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 586.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 759.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 737.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 670.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 518.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 187.66, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 670.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 663.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 187.66, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 187.66, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 714.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 187.66, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 487.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 484.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 670.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 187.66, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 705.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 663.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 663.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 670.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ALTEPLASE INHALATION 1 MG/ML (PEDIATRICS)|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "J2997", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 491.4, "maximum": 580.74, "gross_charge": 893.45, "discounted_cash": 536.07, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 545.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 580.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 531.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 491.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ALTEPLASE 50 MG INTRAVENOUS SOLUTION", "code_information": [{"code": "J2997", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 4691.6, "maximum": 30246.1, "gross_charge": 19107.85, "discounted_cash": 11464.71, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14006.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 14197.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 14197.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 14330.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 14197.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 15911.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10432.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9878.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9439.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10356.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10356.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 14330.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12420.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10241.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14006.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 19845.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 30246.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 16241.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15783.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14006.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 14197.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 11082.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14006.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14330.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14426.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16241.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14426.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12420.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 19845.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 30246.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15783.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 14330.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 4691.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14330.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 14197.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14330.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 4691.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 11082.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 4691.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14330.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10356.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10432.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 4691.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15286.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 4691.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 4691.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 14139.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 13279.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 12420.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 4691.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14006.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14426.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12420.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9267.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10432.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 4691.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 4691.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 19845.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 30246.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 16241.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 16241.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10509.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15783.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14330.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15286.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 15911.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 4691.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 4691.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14330.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15286.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9553.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 4691.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14330.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10432.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ALTEPLASE 50 MG INTRAVENOUS SOLUTION|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "J2997", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 10509.32, "maximum": 12420.1, "gross_charge": 19107.85, "discounted_cash": 11464.71, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11655.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 12420.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 11369.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 10509.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION", "code_information": [{"code": "J3010", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.13, "maximum": 191.8, "gross_charge": 6.45, "discounted_cash": 3.87, "payers_information": [{"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION", "code_information": [{"code": "J3010", "type": "HCPCS"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.13, "maximum": 191.8, "gross_charge": 18.7, "discounted_cash": 11.22, "payers_information": [{"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 25.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 38.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 25.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 38.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 16.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 16.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 25.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 38.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION", "code_information": [{"code": "J3010", "type": "HCPCS"}], "drug_information": {"unit": 20, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.13, "maximum": 191.8, "gross_charge": 64.7, "discounted_cash": 38.82, "payers_information": [{"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 50.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 76.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 50.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 76.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 32.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 32.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 50.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 76.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION", "code_information": [{"code": "J3010", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.13, "maximum": 191.8, "gross_charge": 161.0, "discounted_cash": 96.6, "payers_information": [{"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 121.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 125.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 191.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 132.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 121.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 128.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 119.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 125.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 191.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 132.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 118.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 118.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 119.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 128.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 118.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 119.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 111.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 121.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 118.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 128.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 81.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 118.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 119.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 119.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 119.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 81.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 125.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 191.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 88.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 132.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FENTANYL INFUSION 50 MCG/ML (SYRINGE) (PEDIATRICS)", "code_information": [{"code": "J3010", "type": "HCPCS"}], "drug_information": {"unit": 20, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 32.4, "maximum": 76.72, "gross_charge": 75.6, "discounted_cash": 45.36, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 50.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 76.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 50.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 76.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 32.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 32.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 50.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 76.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FENTANYL IV SYRINGE 4 MCG/ML (PEDIATRICS)", "code_information": [{"code": "J3010", "type": "HCPCS"}], "drug_information": {"unit": 2, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.72, "maximum": 7.67, "gross_charge": 3.55, "discounted_cash": 2.13, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION (INTRANASAL USE)", "code_information": [{"code": "J3010", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.13, "maximum": 7.67, "gross_charge": 6.45, "discounted_cash": 3.87, "payers_information": [{"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION (PEDIATRICS AND ANESTHESIA OSM)", "code_information": [{"code": "J3010", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.13, "maximum": 191.8, "gross_charge": 6.45, "discounted_cash": 3.87, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION (PEDIATRICS AND ANESTHESIA OSM)", "code_information": [{"code": "J3010", "type": "HCPCS"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.13, "maximum": 191.8, "gross_charge": 18.7, "discounted_cash": 11.22, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 16.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 25.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 38.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 16.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 25.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 38.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 25.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 38.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION (PEDIATRICS AND ANESTHESIA OSM)", "code_information": [{"code": "J3010", "type": "HCPCS"}], "drug_information": {"unit": 20, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.13, "maximum": 191.8, "gross_charge": 64.7, "discounted_cash": 38.82, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 32.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 50.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 76.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 32.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 50.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 76.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 50.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 76.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION (PEDIATRICS AND ANESTHESIA OSM)", "code_information": [{"code": "J3010", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.13, "maximum": 191.8, "gross_charge": 160.75, "discounted_cash": 96.45, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 117.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 119.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 119.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 119.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 81.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 125.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 191.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 88.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 132.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 118.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 111.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 121.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 117.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 128.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 81.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 128.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 117.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 117.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 119.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 117.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 121.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 125.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 191.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 132.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 121.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 128.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 119.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 125.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 191.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 132.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TENECTEPLASE 50 MG INTRAVENOUS SOLUTION - FOR STEMI", "code_information": [{"code": "J3101", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 9348.6, "maximum": 29058.0, "gross_charge": 32001.55, "discounted_cash": 19200.93, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 18560.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25601.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 9348.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 9348.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 9348.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23457.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 18560.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23457.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 24001.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 9348.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 9348.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17344.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 9348.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23457.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 29058.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15808.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17152.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 9348.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 9348.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 17600.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 17600.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 9348.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23457.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16000.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 9348.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25601.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 9348.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25601.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 29058.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 9348.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17344.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 24001.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23457.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TENECTEPLASE 50 MG INTRAVENOUS SOLUTION - FOR STROKE", "code_information": [{"code": "J3101", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 9348.6, "maximum": 29058.0, "gross_charge": 32244.85, "discounted_cash": 19346.91, "payers_information": [{"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17283.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15928.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 29058.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23635.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23635.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 24183.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17476.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 9348.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25795.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 29058.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 9348.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25795.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 9348.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16122.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23635.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 9348.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 17734.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 17734.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 9348.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 9348.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 9348.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 9348.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 9348.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25795.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 9348.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17476.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 9348.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 9348.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 24183.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23635.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23635.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 18702.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 18702.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TERBUTALINE 1 MG/ML SOLUTION", "code_information": [{"code": "J3105", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 4.39, "maximum": 15.92, "gross_charge": 9.05, "discounted_cash": 5.43, "payers_information": [{"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 9.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 10.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 15.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 9.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 10.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 15.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 10.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 15.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TERBUTALINE INFUSION 1 MG/ML (PEDIATRICS)", "code_information": [{"code": "J3105", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.56, "maximum": 796.2, "gross_charge": 7.35, "discounted_cash": 4.41, "payers_information": [{"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 9.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 10.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 15.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 10.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 15.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 10.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 15.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 9.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TERBUTALINE INFUSION 1 MG/ML (PEDIATRICS)", "code_information": [{"code": "J3105", "type": "HCPCS"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.56, "maximum": 796.2, "gross_charge": 83.1, "discounted_cash": 49.86, "payers_information": [{"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 92.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 104.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 159.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 104.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 159.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 104.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 159.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 92.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TERBUTALINE INFUSION 1 MG/ML (PEDIATRICS)", "code_information": [{"code": "J3105", "type": "HCPCS"}], "drug_information": {"unit": 20, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.56, "maximum": 796.2, "gross_charge": 151.75, "discounted_cash": 91.05, "payers_information": [{"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 111.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 111.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 113.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 185.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 208.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 318.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 128.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 128.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 125.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 113.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 208.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 318.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 128.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 125.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 111.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 88.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 111.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 111.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 113.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 113.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 88.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 113.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 121.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 113.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 113.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 128.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 208.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 318.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 125.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 113.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 121.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 185.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 113.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 121.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TERBUTALINE INFUSION 1 MG/ML (PEDIATRICS)", "code_information": [{"code": "J3105", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.56, "maximum": 796.2, "gross_charge": 379.35, "discounted_cash": 227.61, "payers_information": [{"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 286.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 246.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 183.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 189.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 278.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 246.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 208.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 208.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 207.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 203.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 207.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 196.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 187.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 278.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 281.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 281.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 284.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 281.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 463.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 522.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 796.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 322.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 322.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 208.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 313.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 286.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 246.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 286.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 284.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 522.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 796.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 322.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 313.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 278.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 281.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 220.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 278.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 278.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 284.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 246.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 205.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 205.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 284.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 220.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 284.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 281.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 303.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 207.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 205.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 284.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 284.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 322.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 522.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 796.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 313.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 207.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 284.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 303.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 463.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 284.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 303.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TESTOSTERONE ENANTHATE 200 MG/ML INTRAMUSCULAR OIL", "code_information": [{"code": "J3121", "type": "HCPCS"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 180.98, "maximum": 322.35, "gross_charge": 373.15, "discounted_cash": 223.89, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 273.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 277.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 277.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 279.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 277.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 203.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 192.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 184.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 200.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 211.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 322.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 317.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 317.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 205.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 308.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 203.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 276.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 259.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 242.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 273.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 186.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 281.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 242.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 180.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 279.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 203.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 279.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 298.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 279.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 298.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 202.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 202.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 279.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 242.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 273.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 273.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 273.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 277.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 216.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 211.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 322.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 317.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 308.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 279.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 281.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 317.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 281.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 242.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 211.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 322.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 308.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 279.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 279.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 202.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 203.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 298.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 277.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 279.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 216.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 279.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CHLORPROMAZINE 25 MG/ML INJECTION SOLUTION", "code_information": [{"code": "J3230", "type": "HCPCS"}], "drug_information": {"unit": 2, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 59.15, "maximum": 153.25, "gross_charge": 121.95, "discounted_cash": 73.17, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 91.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 100.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 153.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 97.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 97.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 91.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 100.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 153.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 100.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 153.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 97.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TIGECYCLINE 50 MG INTRAVENOUS SOLUTION", "code_information": [{"code": "J3243", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 86.0, "maximum": 422.48, "gross_charge": 528.1, "discounted_cash": 316.86, "payers_information": [{"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 286.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 422.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 264.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 422.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 286.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 396.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 387.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 387.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 306.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 387.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 396.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 306.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 86.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 260.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 283.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 290.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 290.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 387.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 422.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 86.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 387.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TIGECYCLINE RECONSTITUTED TO 1 MG/ML (PEDIATRICS)", "code_information": [{"code": "J3243", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 349.68, "maximum": 566.28, "gross_charge": 707.85, "discounted_cash": 424.71, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 566.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 504.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 559.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 389.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 389.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 527.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 349.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 504.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 410.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 530.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 559.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 559.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 410.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 559.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 530.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 383.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 566.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 566.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 383.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 559.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TOBRAMYCIN 1.2 GRAM SOLUTION FOR INJECTION", "code_information": [{"code": "J3260", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 124.65, "maximum": 240.08, "gross_charge": 282.45, "discounted_cash": 169.47, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 207.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 209.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 209.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 211.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 209.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 124.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 154.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 146.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 139.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 151.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 131.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 200.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 240.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 240.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 155.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 233.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 154.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 183.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 155.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 155.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 207.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 141.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 213.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 183.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 211.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 154.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 211.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 225.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 213.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 183.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 131.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 200.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 233.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 240.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 211.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 211.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 153.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 225.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 124.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 153.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 153.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 211.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 183.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 207.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 207.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 131.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 200.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 240.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 233.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 207.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 209.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 163.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 211.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 213.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 163.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 211.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 154.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 225.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 209.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 211.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TOBRAMYCIN 40 MG/ML INJECTION SOLUTION", "code_information": [{"code": "J3260", "type": "HCPCS"}], "drug_information": {"unit": 2, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 4.05, "maximum": 13.35, "gross_charge": 8.35, "discounted_cash": 5.01, "payers_information": [{"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 13.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 13.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 13.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TOCILIZUMAB 80 MG/4 ML (20 MG/ML) INTRAVENOUS SOLUTION", "code_information": [{"code": "J3262", "type": "HCPCS"}], "drug_information": {"unit": 4, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 448.72, "maximum": 2893.41, "gross_charge": 2306.6, "discounted_cash": 1383.96, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1690.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 1713.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1713.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 1729.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1713.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1565.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1259.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1192.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1139.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1236.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1898.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 2893.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1960.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 1960.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1268.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1905.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 448.72, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 448.72, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 1706.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1603.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 1499.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1259.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 448.72, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1690.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 701.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1741.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1499.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1118.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 448.72, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1729.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1729.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1845.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1259.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 448.72, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1729.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1845.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1565.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1250.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1250.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1729.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1499.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 448.72, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1690.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1898.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 2893.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 1960.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1905.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1690.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1713.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1337.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1690.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1729.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1741.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1960.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1741.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1499.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1898.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 2893.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1905.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1729.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 448.72, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 448.72, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1729.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1250.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1259.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 448.72, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1845.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 448.72, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 448.72, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1713.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1729.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 448.72, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1337.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1729.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TOCILIZUMAB 200 MG/10 ML (20 MG/ML) INTRAVENOUS SOLUTION", "code_information": [{"code": "J3262", "type": "HCPCS"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 1121.8, "maximum": 7233.53, "gross_charge": 5766.5, "discounted_cash": 3459.9, "payers_information": [{"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4324.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3344.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1121.8, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4324.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4284.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1121.8, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1121.8, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4613.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1121.8, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3148.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3125.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4324.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1121.8, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1121.8, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 4324.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4746.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 7233.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4763.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4353.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3748.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4901.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4353.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4324.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4226.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4226.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4284.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3344.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4746.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 7233.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4901.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4763.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4226.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1121.8, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 4324.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3748.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3125.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3125.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4324.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4613.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3914.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1121.8, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3148.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4324.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4613.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4324.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1121.8, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4353.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3748.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2796.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1753.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4226.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1121.8, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3148.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 4267.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4007.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 3748.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1121.8, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1121.8, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4746.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 7233.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4901.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4901.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3171.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4763.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3090.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3148.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2981.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2848.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4284.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3914.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4226.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 4284.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4284.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 4324.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TOCILIZUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION", "code_information": [{"code": "J3262", "type": "HCPCS"}], "drug_information": {"unit": 20, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 2243.6, "maximum": 14467.07, "gross_charge": 11533.0, "discounted_cash": 6919.8, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8453.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 8569.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 8569.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 8649.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 8569.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7828.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6297.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5962.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5697.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6181.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 9492.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 14467.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 9803.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 9803.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 6343.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9526.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2243.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2243.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 8534.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 8015.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 7496.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6297.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2243.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8453.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3506.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8707.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7496.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5593.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2243.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8649.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8649.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9226.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6297.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2243.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8649.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9226.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7828.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6250.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6250.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 8649.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7496.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2243.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8453.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 9492.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 14467.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 9803.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9526.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8453.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 8569.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6689.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8453.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8649.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8707.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9803.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8707.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7496.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 9492.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 14467.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9526.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 8649.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2243.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2243.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8649.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6250.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6297.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2243.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9226.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2243.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2243.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 8569.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8649.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2243.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6689.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8649.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TOCILIZUMAB 162 MG/0.9 ML SUBCUTANEOUS SYRINGE", "code_information": [{"code": "J3262", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "minimum": 908.66, "maximum": 5859.16, "gross_charge": 4818.25, "discounted_cash": 2890.95, "payers_information": [{"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3613.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3579.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3170.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2582.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2630.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2491.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2380.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 3565.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 3348.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 3131.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 908.66, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 908.66, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3844.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 5859.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4095.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4095.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2650.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3979.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2611.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2611.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3613.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3854.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3170.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 908.66, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2630.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3613.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3854.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3613.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 908.66, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3637.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3131.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2336.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1420.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3531.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 908.66, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2630.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2794.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 908.66, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3613.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3579.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 908.66, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 908.66, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3854.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 908.66, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2630.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2611.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3613.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 908.66, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 908.66, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3613.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3844.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 5859.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3979.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3637.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3131.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4095.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3637.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3613.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3531.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3531.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3579.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2794.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3844.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 5859.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4095.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3979.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3531.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 908.66, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3613.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3131.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3531.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 3579.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3579.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 3613.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TREPROSTINIL SODIUM 1 MG/ML INJECTION SOLUTION", "code_information": [{"code": "J3285", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 2724.0, "maximum": 17561.63, "gross_charge": 20221.95, "discounted_cash": 12133.17, "payers_information": [{"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2724.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15166.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15166.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16177.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3965.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14822.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 15024.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 15024.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 15166.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11041.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10454.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9989.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11522.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 17561.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 17188.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 17188.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 11122.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16703.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 15024.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 9376.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2724.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2724.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 13144.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 12032.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 11122.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10838.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11041.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2724.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14822.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15267.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13144.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9807.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12335.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16177.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 9376.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11041.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2724.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10960.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10960.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 15166.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13144.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2724.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14822.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14822.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 15024.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 11728.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11522.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 17561.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 17188.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16703.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14822.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15166.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15267.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17188.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11522.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 17561.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16703.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15267.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13144.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 15166.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2724.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2724.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15166.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10960.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11041.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2724.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16177.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2724.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2724.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 15024.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15166.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2724.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 11728.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15166.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TREPROSTINIL SODIUM 2.5 MG/ML INJECTION SOLUTION", "code_information": [{"code": "J3285", "type": "HCPCS"}], "drug_information": {"unit": 20, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 2724.0, "maximum": 43904.07, "gross_charge": 18900.25, "discounted_cash": 11340.15, "payers_information": [{"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14175.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 10962.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2724.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14175.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 14042.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2724.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2724.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15120.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2724.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10319.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10243.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14175.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2724.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2724.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 14175.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14269.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12285.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11522.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 17561.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15611.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16065.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14269.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14175.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13853.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11522.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 17561.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 16065.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15611.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13853.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 14042.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 10962.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13853.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2724.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 14175.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12285.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10243.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10243.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2724.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10319.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11529.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15120.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 9376.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14269.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12285.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9166.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13853.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2724.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10319.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10130.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 12285.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 11245.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 10395.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2724.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2724.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 14042.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 9376.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11522.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 17561.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 16065.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 16065.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10395.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15611.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10319.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9771.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9336.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13853.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 14042.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 14042.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 14175.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3965.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14175.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15120.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14175.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2724.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TREPROSTINIL SODIUM 2.5 MG/ML INJECTION SOLUTION", "code_information": [{"code": "J3285", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 2724.0, "maximum": 43904.07, "gross_charge": 47250.65, "discounted_cash": 28350.39, "payers_information": [{"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35437.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 27405.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 6810.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35437.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 35107.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 6810.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 6810.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37800.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 6810.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25798.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25609.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35437.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 6810.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 6810.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 35437.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35674.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30712.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 28806.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 43904.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39029.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40163.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35674.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35437.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34634.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 28806.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 43904.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 40163.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39029.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34634.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 35107.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 27405.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34634.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 6810.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 35437.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30712.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25609.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25609.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 6810.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25798.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28822.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37800.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 23440.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35674.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30712.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22916.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34634.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 6810.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25798.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25326.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 30712.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 28114.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 25987.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 6810.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 6810.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 35107.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 23440.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 28806.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 43904.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 40163.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 40163.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 25987.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39029.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25798.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24428.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23341.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34634.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 35107.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 35107.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 35437.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 9913.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35437.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37800.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35437.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 6810.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TREPROSTINIL SODIUM 5 MG/ML INJECTION SOLUTION", "code_information": [{"code": "J3285", "type": "HCPCS"}], "drug_information": {"unit": 20, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 5448.0, "maximum": 35123.26, "gross_charge": 15916.55, "discounted_cash": 9549.93, "payers_information": [{"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5448.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11937.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11937.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12733.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7931.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11666.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 11826.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 11826.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 11937.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8690.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8228.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7862.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 23045.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 35123.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 13529.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 13529.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 8754.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13147.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 11826.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 18752.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5448.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5448.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 10345.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 9470.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 8754.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8531.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8690.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5448.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11666.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12017.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10345.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7719.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9709.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12733.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 18752.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8690.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5448.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8626.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8626.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 11937.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10345.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5448.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11666.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11666.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 11826.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 9231.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 23045.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 35123.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 13529.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13147.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11666.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11937.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12017.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13529.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 23045.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 35123.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13147.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12017.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10345.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 11937.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5448.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5448.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11937.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8626.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8690.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5448.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12733.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5448.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5448.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 11826.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11937.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5448.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 9231.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11937.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TREPROSTINIL SODIUM 10 MG/ML INJECTION SOLUTION", "code_information": [{"code": "J3285", "type": "HCPCS"}], "drug_information": {"unit": 20, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 10896.0, "maximum": 175616.28, "gross_charge": 75603.7, "discounted_cash": 45362.22, "payers_information": [{"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56702.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 43850.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 10896.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56702.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 56173.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 10896.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 10896.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60482.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 10896.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41279.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40977.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56702.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 10896.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 10896.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 56702.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 57080.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49142.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 46090.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 70246.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 62448.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 64263.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 57080.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56702.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 55417.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 46090.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 70246.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 64263.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 62448.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 55417.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 56173.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 43850.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 55417.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 10896.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 56702.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49142.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40977.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40977.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 10896.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41279.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46118.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60482.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 37504.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 57080.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49142.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36667.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 55417.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 10896.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41279.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40523.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 49142.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 44984.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 41582.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 10896.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 10896.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 56173.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 37504.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 46090.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 70246.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 64263.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 64263.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 41582.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 62448.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41279.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39087.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37348.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 55417.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 56173.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 56173.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 56702.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 15862.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56702.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60482.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56702.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 10896.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TREPROSTINIL SODIUM 10 MG/ML INJECTION SOLUTION", "code_information": [{"code": "J3285", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 10896.0, "maximum": 175616.28, "gross_charge": 189009.15, "discounted_cash": 113405.49, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 109625.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 27240.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 141756.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 140433.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 27240.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 27240.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 151207.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 27240.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 103199.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 102442.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 141756.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 27240.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 27240.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 141756.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 142701.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 122855.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 115225.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 175616.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 156121.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 160657.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 142701.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 141756.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 138543.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 115225.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 175616.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 160657.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 156121.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 138543.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 140433.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 109625.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 138543.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 27240.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 141756.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 122855.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 102442.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 102442.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 27240.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 103199.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 115295.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 151207.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 93760.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 142701.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 122855.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91669.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 141756.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 138543.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 27240.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 103199.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 101308.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 122855.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 112460.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 103955.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 27240.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 27240.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 140433.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 93760.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 115225.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 175616.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 160657.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 160657.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 103955.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 156121.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 103199.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 97717.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 93370.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 138543.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 140433.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 140433.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 141756.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 39655.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 141756.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 151207.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 141756.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 27240.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION", "code_information": [{"code": "J3290", "type": "HCPCS"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 2.5, "maximum": 38.68, "gross_charge": 13.75, "discounted_cash": 8.25, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 25.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 38.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 25.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 38.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 25.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 38.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TRIAMCINOLONE ACETONIDE (PF) 40 MG/ML INTRAOCULAR SUSPENSION", "code_information": [{"code": "J3300", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 979.64, "maximum": 6315.48, "gross_charge": 3668.6, "discounted_cash": 2201.16, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2689.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 2725.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2725.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 2751.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2725.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3313.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2003.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1896.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1812.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1966.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4143.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 6315.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 3118.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 3118.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2017.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3030.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 979.64, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 979.64, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2003.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 2714.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 2549.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 2384.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 979.64, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2689.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1834.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2769.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2384.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1779.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 979.64, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2751.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2003.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2751.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2934.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 979.64, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2751.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2934.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3313.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 979.64, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1988.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1988.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2751.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2384.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2689.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2689.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2689.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2725.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2127.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4143.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 6315.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 3118.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3030.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2751.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2769.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3118.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2769.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2384.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4143.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 6315.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3030.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2751.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 979.64, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 979.64, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2751.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1988.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2003.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 979.64, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2934.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 979.64, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 979.64, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2725.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2751.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 979.64, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2127.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2751.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TRIAMCINOLONE ACETONIDE 10 MG/ML SUSPENSION FOR INJECTION", "code_information": [{"code": "J3301", "type": "HCPCS"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 14.55, "maximum": 54.06, "gross_charge": 63.6, "discounted_cash": 38.16, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 14.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 15.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 23.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 14.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 15.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 23.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 15.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 23.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION", "code_information": [{"code": "J3301", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 6.64, "maximum": 19.08, "gross_charge": 13.7, "discounted_cash": 8.22, "payers_information": [{"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 12.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 19.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 12.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 19.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 12.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 19.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TRIAMCINOLONE HEXACETONIDE 20 MG/ML SUSPENSION FOR INJECTION", "code_information": [{"code": "J3303", "type": "HCPCS"}], "drug_information": {"unit": 2, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 178.21, "maximum": 419.31, "gross_charge": 367.45, "discounted_cash": 220.47, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 269.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 273.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 273.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 275.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 273.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 263.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 200.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 189.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 181.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 196.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 275.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 419.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 312.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 312.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 202.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 303.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 200.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 271.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 255.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 238.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 269.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 183.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 277.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 238.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 178.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 275.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 200.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 275.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 293.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 275.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 293.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 263.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 199.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 199.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 275.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 238.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 269.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 269.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 269.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 273.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 213.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 275.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 419.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 312.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 303.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 275.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 277.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 312.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 277.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 238.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 275.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 419.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 303.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 275.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 275.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 199.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 200.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 293.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 273.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 275.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 213.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 275.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "USTEKINUMAB 130 MG/26 ML INTRAVENOUS SOLUTION", "code_information": [{"code": "J3358", "type": "HCPCS"}], "drug_information": {"unit": 26, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 1623.7, "maximum": 10467.99, "gross_charge": 9414.55, "discounted_cash": 5648.73, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6900.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 6995.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 6995.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 7060.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 6995.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5839.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5140.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4867.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4650.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5046.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6868.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 10467.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 8002.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 8002.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5178.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7776.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1623.7, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1623.7, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5140.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 6966.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 6543.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 6119.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1623.7, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6900.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2672.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7107.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6119.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4566.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1623.7, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7060.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5140.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7060.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7531.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1623.7, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7060.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7531.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5839.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1623.7, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5102.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5102.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 7060.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6119.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6900.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6900.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6900.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 6995.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 5460.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6868.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 10467.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 8002.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7776.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7060.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7107.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8002.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7107.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6119.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6868.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 10467.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7776.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 7060.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1623.7, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1623.7, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7060.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5102.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5140.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1623.7, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7531.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1623.7, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1623.7, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 6995.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7060.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1623.7, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 5460.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7060.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DIAZEPAM 5 MG/ML INJECTION SOLUTION (SO)", "code_information": [{"code": "J3360", "type": "HCPCS"}], "drug_information": {"unit": 2, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 41.7, "maximum": 86.26, "gross_charge": 90.3, "discounted_cash": 54.18, "payers_information": [{"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 56.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 86.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 56.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 86.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 41.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 56.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 86.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 41.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DIAZEPAM 5 MG/ML INJECTION SOLUTION (SO) (PEDIATRICS)", "code_information": [{"code": "J3360", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "minimum": 20.85, "maximum": 57.84, "gross_charge": 68.05, "discounted_cash": 40.83, "payers_information": [{"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 28.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 43.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 28.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 43.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 20.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 28.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 43.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 20.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "VANCOMYCIN IV SYRINGE 5 MG/ML (PEDIATRICS)", "code_information": [{"code": "J3373", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 2.5, "maximum": 4.84, "gross_charge": 5.2, "discounted_cash": 3.12, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "VANCOMYCIN IV SYRINGE 5 MG/ML (PEDIATRICS)|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "J3373", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 2.86, "maximum": 2.86, "gross_charge": 5.2, "discounted_cash": 3.12, "payers_information": [{"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "VANCOMYCIN 5 MG/ML (ANTIBIOTIC LOCK THERAPY)", "code_information": [{"code": "J3373", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.07, "maximum": 0.19, "gross_charge": 0.15, "discounted_cash": 0.09, "payers_information": [{"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "VANCOMYCIN 5 MG/ML (ANTIBIOTIC LOCK THERAPY)|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "J3373", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.08, "maximum": 0.08, "gross_charge": 0.15, "discounted_cash": 0.09, "payers_information": [{"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "VANCOMYCIN 2.5 MG/ML, HEPARIN 2,500 UNITS/ML IN 0.9% SODIUM CHLORIDE 1 ML (ANTIBIOTIC LOCK THERAPY)", "code_information": [{"code": "J3373", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 15.18, "maximum": 26.61, "gross_charge": 31.3, "discounted_cash": 18.78, "payers_information": [{"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "VANCOMYCIN IV SYRINGE 5 MG/ML (NON-STANDARD) (PEDIATRICS)", "code_information": [{"code": "J3373", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 2.5, "maximum": 4.84, "gross_charge": 5.35, "discounted_cash": 3.21, "payers_information": [{"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "VANCOMYCIN IV SYRINGE 5 MG/ML (NON-STANDARD) (PEDIATRICS)|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "J3373", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 2.94, "maximum": 2.94, "gross_charge": 5.35, "discounted_cash": 3.21, "payers_information": [{"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "VANCOMYCIN 5 GM INTRAVENOUS SOLUTION (USE FOR NEBULIZATION MIXTURE)", "code_information": [{"code": "J3373", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 47.82, "maximum": 96.71, "gross_charge": 98.6, "discounted_cash": 59.16, "payers_information": [{"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 50.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 63.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 96.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 50.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 63.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 96.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 63.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 96.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "VANCOMYCIN IVPB 5 MG/ML (PEDIATRICS)", "code_information": [{"code": "J3373", "type": "HCPCS"}], "drug_information": {"unit": 100, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 5.0, "maximum": 9.67, "gross_charge": 10.4, "discounted_cash": 6.24, "payers_information": [{"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 9.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 9.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 9.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "VANCOMYCIN IVPB 5 MG/ML (PEDIATRICS)|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "J3373", "type": "HCPCS"}], "drug_information": {"unit": 100, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 5.72, "maximum": 5.72, "gross_charge": 10.4, "discounted_cash": 6.24, "payers_information": [{"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION", "code_information": [{"code": "J3373", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 10.0, "maximum": 19.34, "gross_charge": 22.0, "discounted_cash": 13.2, "payers_information": [{"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 12.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 19.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 12.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 19.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 10.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 10.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 12.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 19.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "J3373", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 12.1, "maximum": 12.1, "gross_charge": 22.0, "discounted_cash": 13.2, "payers_information": [{"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "VANCOMYCIN 500 MG INTRAVENOUS SOLUTION", "code_information": [{"code": "J3373", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 5.0, "maximum": 11.9, "gross_charge": 14.0, "discounted_cash": 8.4, "payers_information": [{"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 9.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 9.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 9.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "J3373", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 7.7, "maximum": 7.7, "gross_charge": 14.0, "discounted_cash": 8.4, "payers_information": [{"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION", "code_information": [{"code": "J3373", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 46.61, "maximum": 96.71, "gross_charge": 96.1, "discounted_cash": 57.66, "payers_information": [{"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 50.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 63.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 96.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 50.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 63.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 96.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 63.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 96.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) INTRAVENOUS SOLUTION", "code_information": [{"code": "J3379", "type": "HCPCS"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 7.34, "maximum": 11.88, "gross_charge": 14.85, "discounted_cash": 8.91, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "VEDOLIZUMAB 300 MG INTRAVENOUS SOLUTION", "code_information": [{"code": "J3380", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 6411.3, "maximum": 41331.72, "gross_charge": 29600.95, "discounted_cash": 17760.57, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21697.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 21993.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 21993.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 22200.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 21993.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 22368.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16162.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15303.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14622.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15866.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 27118.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 41331.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 25160.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 25160.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 16280.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24450.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 6411.3, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 6411.3, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16162.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 21904.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 20572.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 19240.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 6411.3, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21697.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11441.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22348.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19240.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14356.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 6411.3, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22200.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16162.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22200.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23680.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 6411.3, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22200.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23680.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 22368.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 6411.3, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16043.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16043.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 22200.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19240.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21697.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21697.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21697.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 21993.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 17168.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 27118.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 41331.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 25160.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24450.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22200.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22348.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25160.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22348.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19240.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 27118.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 41331.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24450.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 22200.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 6411.3, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 6411.3, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22200.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16043.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16162.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 6411.3, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23680.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 6411.3, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 6411.3, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 21993.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22200.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 6411.3, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 17168.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22200.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "VELAGLUCERASE ALFA 400 UNIT INTRAVENOUS SOLUTION", "code_information": [{"code": "J3385", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1545.71, "maximum": 9965.26, "gross_charge": 6687.9, "discounted_cash": 4012.74, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4902.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 4969.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4969.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 5015.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4969.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5140.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3651.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3457.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3303.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3584.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6538.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 9965.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 5684.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5684.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3678.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5524.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1545.71, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1545.71, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3651.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 4949.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4648.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 4347.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1545.71, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4902.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1928.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5049.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4347.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3243.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1545.71, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5015.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3651.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5015.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5350.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1545.71, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5015.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5350.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5140.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1545.71, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3624.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3624.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 5015.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4347.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4902.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4902.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4902.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4969.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3878.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6538.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 9965.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5684.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5524.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5015.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5049.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5684.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5049.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4347.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6538.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 9965.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5524.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 5015.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1545.71, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1545.71, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5015.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3624.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3651.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1545.71, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5350.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1545.71, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1545.71, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4969.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5015.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1545.71, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3878.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5015.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ONASEMNOGENE ABEPARVOVEC-XIOI 2 X 10EXP13 VG/ML IV SUSPENSION 16.6 ML", "code_information": [{"code": "J3399", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.04, "maximum": 8288150.73, "gross_charge": 5022581.95, "discounted_cash": 3013549.17, "payers_information": [{"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 3716710.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 3490694.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2435952.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3065098.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2913097.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2692103.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2762420.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8288150.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2596674.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2481155.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2913097.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8288150.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ONASEMNOGENE ABEPARVOVEC-XIOI 2 X 10EXP13 VG/ML IV SUSPENSION 19.3 ML", "code_information": [{"code": "J3399", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.04, "maximum": 8288150.73, "gross_charge": 5022581.95, "discounted_cash": 3013549.17, "payers_information": [{"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8288150.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2913097.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2596674.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2481155.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8288150.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2762420.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2692103.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2913097.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3065098.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2435952.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 3716710.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 3490694.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ONASEMNOGENE ABEPARVOVEC-XIOI 2 X 10EXP13 VG/ML IV SUSPENSION 22.1 ML", "code_information": [{"code": "J3399", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.04, "maximum": 8288150.73, "gross_charge": 5022581.95, "discounted_cash": 3013549.17, "payers_information": [{"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 3716710.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 3490694.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2435952.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3065098.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2913097.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2692103.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2762420.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8288150.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2596674.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2481155.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2913097.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8288150.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ONASEMNOGENE ABEPARVOVEC-XIOI 2 X 10EXP13 VG/ML IV SUSPENSION 24.9 ML", "code_information": [{"code": "J3399", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.04, "maximum": 8288150.73, "gross_charge": 5022581.95, "discounted_cash": 3013549.17, "payers_information": [{"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8288150.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2913097.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2596674.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2481155.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8288150.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2762420.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2692103.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2913097.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3065098.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2435952.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 3716710.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 3490694.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ONASEMNOGENE ABEPARVOVEC-XIOI 2 X 10EXP13 VG/ML IV SUSPENSION 27.6 ML", "code_information": [{"code": "J3399", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.04, "maximum": 8288150.73, "gross_charge": 5022581.95, "discounted_cash": 3013549.17, "payers_information": [{"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 3716710.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 3490694.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2435952.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3065098.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2913097.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2692103.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2762420.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8288150.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2596674.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2481155.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2913097.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8288150.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ONASEMNOGENE ABEPARVOVEC-XIOI 2 X 10EXP13 VG/ML IV SUSPENSION 30.4 ML", "code_information": [{"code": "J3399", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.04, "maximum": 8288150.73, "gross_charge": 5022581.95, "discounted_cash": 3013549.17, "payers_information": [{"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8288150.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2913097.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2596674.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2481155.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8288150.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2762420.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2692103.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2913097.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3065098.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2435952.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 3716710.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 3490694.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ONASEMNOGENE ABEPARVOVEC-XIOI 2 X 10EXP13 VG/ML IV SUSPENSION 33.2 ML", "code_information": [{"code": "J3399", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.04, "maximum": 8288150.73, "gross_charge": 5022581.95, "discounted_cash": 3013549.17, "payers_information": [{"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 3716710.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 3490694.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2435952.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3065098.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2913097.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2692103.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2762420.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8288150.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2596674.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2481155.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2913097.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8288150.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ONASEMNOGENE ABEPARVOVEC-XIOI 2 X 10EXP13 VG/ML IV SUSPENSION 35.9 ML", "code_information": [{"code": "J3399", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.04, "maximum": 8288150.73, "gross_charge": 5022581.95, "discounted_cash": 3013549.17, "payers_information": [{"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8288150.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2913097.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2596674.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2481155.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8288150.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2762420.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2692103.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2913097.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3065098.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2435952.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 3716710.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 3490694.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ONASEMNOGENE ABEPARVOVEC-XIOI 2 X 10EXP13 VG/ML IV SUSPENSION 38.7 ML", "code_information": [{"code": "J3399", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.04, "maximum": 8288150.73, "gross_charge": 5022581.95, "discounted_cash": 3013549.17, "payers_information": [{"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 3716710.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 3490694.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2435952.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3065098.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2913097.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2692103.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8288150.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2596674.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2481155.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2913097.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2762420.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8288150.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ONASEMNOGENE ABEPARVOVEC-XIOI 2 X 10EXP13 VG/ML IV SUSPENSION 41.5 ML", "code_information": [{"code": "J3399", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.04, "maximum": 8288150.73, "gross_charge": 5022581.95, "discounted_cash": 3013549.17, "payers_information": [{"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8288150.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2762420.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2913097.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2596674.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2481155.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8288150.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2692103.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2913097.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3065098.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2435952.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 3716710.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 3490694.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ONASEMNOGENE ABEPARVOVEC-XIOI 2 X 10EXP13 VG/ML IV SUSPENSION 44.2 ML", "code_information": [{"code": "J3399", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.04, "maximum": 8288150.73, "gross_charge": 5022581.95, "discounted_cash": 3013549.17, "payers_information": [{"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 3716710.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 3490694.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2435952.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3065098.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2913097.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2692103.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8288150.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2596674.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2481155.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2913097.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2762420.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8288150.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ONASEMNOGENE ABEPARVOVEC-XIOI 2 X 10EXP13 VG/ML IV SUSPENSION 47 ML", "code_information": [{"code": "J3399", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.04, "maximum": 8288150.73, "gross_charge": 5022581.95, "discounted_cash": 3013549.17, "payers_information": [{"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8288150.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2762420.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2913097.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2596674.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2481155.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8288150.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2692103.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2913097.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3065098.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2435952.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 3716710.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 3490694.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ONASEMNOGENE ABEPARVOVEC-XIOI 2 X 10EXP13 VG/ML IV SUSPENSION 49.8 ML", "code_information": [{"code": "J3399", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.04, "maximum": 8288150.73, "gross_charge": 5022581.95, "discounted_cash": 3013549.17, "payers_information": [{"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 3716710.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 3490694.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2435952.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3065098.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2913097.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2692103.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8288150.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2596674.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2481155.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2913097.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2762420.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8288150.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ONASEMNOGENE ABEPARVOVEC-XIOI 2 X 10EXP13 VG/ML IV SUSPENSION 52.5 ML", "code_information": [{"code": "J3399", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.04, "maximum": 8288150.73, "gross_charge": 5022581.95, "discounted_cash": 3013549.17, "payers_information": [{"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8288150.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2762420.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2913097.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2596674.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2481155.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8288150.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2692103.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2913097.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3065098.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2435952.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 3716710.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 3490694.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ONASEMNOGENE ABEPARVOVEC-XIOI 2 X 10EXP13 VG/ML IV SUSPENSION 55.3 ML", "code_information": [{"code": "J3399", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.04, "maximum": 8288150.73, "gross_charge": 5022581.95, "discounted_cash": 3013549.17, "payers_information": [{"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 3716710.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 3490694.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2435952.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3065098.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2913097.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2692103.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8288150.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2596674.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2481155.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2913097.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2762420.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8288150.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ONASEMNOGENE ABEPARVOVEC-XIOI 2 X 10EXP13 VG/ML IV SUSPENSION 58.1 ML", "code_information": [{"code": "J3399", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.04, "maximum": 8288150.73, "gross_charge": 5022581.95, "discounted_cash": 3013549.17, "payers_information": [{"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8288150.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2762420.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2913097.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2596674.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2481155.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8288150.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2692103.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2913097.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3065098.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2435952.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 3716710.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 3490694.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ONASEMNOGENE ABEPARVOVEC-XIOI 2 X 10EXP13 VG/ML IV SUSPENSION 60.8 ML", "code_information": [{"code": "J3399", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.04, "maximum": 8288150.73, "gross_charge": 5022581.95, "discounted_cash": 3013549.17, "payers_information": [{"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 3716710.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 3490694.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2435952.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3065098.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2913097.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2692103.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8288150.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2596674.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2481155.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2913097.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2762420.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8288150.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ONASEMNOGENE ABEPARVOVEC-XIOI 2 X 10EXP13 VG/ML IV SUSPENSION 63.6 ML", "code_information": [{"code": "J3399", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.04, "maximum": 8288150.73, "gross_charge": 5022581.95, "discounted_cash": 3013549.17, "payers_information": [{"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8288150.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2762420.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2913097.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2596674.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2481155.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8288150.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2692103.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2913097.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3065098.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2435952.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 3716710.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 3490694.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ONASEMNOGENE ABEPARVOVEC-XIOI 2 X 10EXP13 VG/ML IV SUSPENSION 66.4 ML", "code_information": [{"code": "J3399", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.04, "maximum": 8288150.73, "gross_charge": 5022581.95, "discounted_cash": 3013549.17, "payers_information": [{"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 3716710.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 3490694.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2435952.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3065098.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2913097.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2692103.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8288150.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2596674.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2481155.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2913097.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2762420.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8288150.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ONASEMNOGENE ABEPARVOVEC-XIOI 2 X 10EXP13 VG/ML IV SUSPENSION 69.1 ML", "code_information": [{"code": "J3399", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.04, "maximum": 8288150.73, "gross_charge": 5022581.95, "discounted_cash": 3013549.17, "payers_information": [{"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8288150.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2762420.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2435952.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2913097.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2596674.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2481155.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8288150.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2692103.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2913097.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3065098.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 3716710.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 3490694.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ONASEMNOGENE ABEPARVOVEC-XIOI 2 X 10EXP13 VG/ML IV SUSPENSION 71.9 ML", "code_information": [{"code": "J3399", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.04, "maximum": 8288150.73, "gross_charge": 5022581.95, "discounted_cash": 3013549.17, "payers_information": [{"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 3716710.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 3490694.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3065098.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2913097.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2692103.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8288150.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2596674.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2481155.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2913097.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2435952.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2762420.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8288150.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ONASEMNOGENE ABEPARVOVEC-XIOI 2 X 10EXP13 VG/ML IV SUSPENSION 74.7 ML", "code_information": [{"code": "J3399", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.04, "maximum": 8288150.73, "gross_charge": 5022581.95, "discounted_cash": 3013549.17, "payers_information": [{"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8288150.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2762420.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2435952.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2913097.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2596674.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2481155.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8288150.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2692103.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2913097.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3065098.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 3716710.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 3490694.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ONASEMNOGENE ABEPARVOVEC-XIOI 2 X 10EXP13 VG/ML IV SUSPENSION 77.4 ML", "code_information": [{"code": "J3399", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.04, "maximum": 8288150.73, "gross_charge": 5022581.95, "discounted_cash": 3013549.17, "payers_information": [{"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2692103.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8288150.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2596674.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2481155.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 3716710.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 3490694.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3065098.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2913097.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2913097.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2435952.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2762420.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8288150.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ONASEMNOGENE ABEPARVOVEC-XIOI 2 X 10EXP13 VG/ML IV SUSPENSION 80.2 ML", "code_information": [{"code": "J3399", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.04, "maximum": 8288150.73, "gross_charge": 5022581.95, "discounted_cash": 3013549.17, "payers_information": [{"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8288150.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2762420.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2435952.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2913097.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2913097.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3065098.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 3716710.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 3490694.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2596674.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2481155.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8288150.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2692103.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ONASEMNOGENE ABEPARVOVEC-XIOI 2 X 10EXP13 VG/ML IV SUSPENSION 83 ML", "code_information": [{"code": "J3399", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.04, "maximum": 8288150.73, "gross_charge": 5022581.95, "discounted_cash": 3013549.17, "payers_information": [{"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2692103.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8288150.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2596674.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2481155.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 3716710.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 3490694.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3065098.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2913097.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2913097.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2435952.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2762420.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8288150.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ONASEMNOGENE ABEPARVOVEC-XIOI 2 X 10EXP13 VG/ML IV SUSPENSION 85.7 ML", "code_information": [{"code": "J3399", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.04, "maximum": 8288150.73, "gross_charge": 5022581.95, "discounted_cash": 3013549.17, "payers_information": [{"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8288150.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2762420.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2435952.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2913097.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2913097.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3065098.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 3716710.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 3490694.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2596674.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2481155.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8288150.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2692103.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ONASEMNOGENE ABEPARVOVEC-XIOI 2 X 10EXP13 VG/ML IV SUSPENSION 88.5 ML", "code_information": [{"code": "J3399", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.04, "maximum": 8288150.73, "gross_charge": 5022581.95, "discounted_cash": 3013549.17, "payers_information": [{"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2692103.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8288150.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2596674.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2481155.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 3716710.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 3490694.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3065098.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2913097.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2913097.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2435952.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2762420.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8288150.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ONASEMNOGENE ABEPARVOVEC-XIOI 2 X 10EXP13 VG/ML IV SUSPENSION 91.3 ML", "code_information": [{"code": "J3399", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.04, "maximum": 8288150.73, "gross_charge": 5022581.95, "discounted_cash": 3013549.17, "payers_information": [{"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8288150.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2762420.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2435952.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2913097.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2913097.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3065098.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 3716710.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 3490694.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2596674.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2481155.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8288150.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2692103.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ONASEMNOGENE ABEPARVOVEC-XIOI 2 X 10EXP13 VG/ML IV SUSPENSION 94 ML", "code_information": [{"code": "J3399", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.04, "maximum": 8288150.73, "gross_charge": 5022581.95, "discounted_cash": 3013549.17, "payers_information": [{"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2692103.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8288150.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2596674.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2481155.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 3716710.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 3490694.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3065098.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2913097.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2913097.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2435952.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2762420.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8288150.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ONASEMNOGENE ABEPARVOVEC-XIOI 2 X 10EXP13 VG/ML IV SUSPENSION 96.8 ML", "code_information": [{"code": "J3399", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.04, "maximum": 8288150.73, "gross_charge": 5022581.95, "discounted_cash": 3013549.17, "payers_information": [{"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8288150.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2762420.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2435952.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2913097.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2913097.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3065098.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 3716710.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 3490694.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2596674.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2481155.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8288150.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2692103.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ONASEMNOGENE ABEPARVOVEC-XIOI 2 X 10EXP13 VG/ML IV SUSPENSION 99.6 ML", "code_information": [{"code": "J3399", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.04, "maximum": 8288150.73, "gross_charge": 5022581.95, "discounted_cash": 3013549.17, "payers_information": [{"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2692103.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8288150.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2596674.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2481155.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 3716710.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 3490694.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3065098.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2913097.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2913097.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2435952.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2762420.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8288150.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ONASEMNOGENE ABEPARVOVEC-XIOI 2 X 10EXP13 VG/ML IV SUSPENSION 102.3 ML", "code_information": [{"code": "J3399", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.04, "maximum": 8288150.73, "gross_charge": 5022581.95, "discounted_cash": 3013549.17, "payers_information": [{"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2913097.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8288150.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2762420.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2435952.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2913097.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3065098.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 3716710.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 3490694.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2596674.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2481155.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8288150.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2692103.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ONASEMNOGENE ABEPARVOVEC-XIOI 2 X 10EXP13 VG/ML IV SUSPENSION 105.1 ML", "code_information": [{"code": "J3399", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.04, "maximum": 8288150.73, "gross_charge": 5022581.95, "discounted_cash": 3013549.17, "payers_information": [{"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2692103.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8288150.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2596674.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2481155.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 3716710.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 3490694.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3065098.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2913097.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2435952.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2762420.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8288150.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2913097.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ONASEMNOGENE ABEPARVOVEC-XIOI 2 X 10EXP13 VG/ML IV SUSPENSION 107.9 ML", "code_information": [{"code": "J3399", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.04, "maximum": 8288150.73, "gross_charge": 5022581.95, "discounted_cash": 3013549.17, "payers_information": [{"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2913097.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8288150.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2762420.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2435952.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2913097.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3065098.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 3716710.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 3490694.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2596674.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2481155.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8288150.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2692103.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ONASEMNOGENE ABEPARVOVEC-XIOI 2 X 10EXP13 VG/ML IV SUSPENSION 110.6 ML", "code_information": [{"code": "J3399", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.04, "maximum": 8288150.73, "gross_charge": 5022581.95, "discounted_cash": 3013549.17, "payers_information": [{"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2692103.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8288150.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2596674.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2481155.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 3716710.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 3490694.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3065098.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2913097.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2435952.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2762420.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8288150.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2913097.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ONASEMNOGENE ABEPARVOVEC-XIOI 2 X 10EXP13 VG/ML IV SUSPENSION 113.4 ML", "code_information": [{"code": "J3399", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.04, "maximum": 8288150.73, "gross_charge": 5022581.95, "discounted_cash": 3013549.17, "payers_information": [{"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2913097.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8288150.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2762420.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2435952.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2913097.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3065098.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 3716710.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 3490694.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2596674.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2481155.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8288150.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2692103.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ONASEMNOGENE ABEPARVOVEC-XIOI 2 X 10EXP13 VG/ML IV SUSPENSION 116.2 ML", "code_information": [{"code": "J3399", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.04, "maximum": 8288150.73, "gross_charge": 5022581.95, "discounted_cash": 3013549.17, "payers_information": [{"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2692103.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8288150.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2596674.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2481155.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 3716710.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 3490694.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3065098.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2722239.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2913097.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2435952.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2762420.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2742329.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4018065.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8288150.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4148652.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3681552.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3731778.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2913097.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2588981.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3766936.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4269194.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3792049.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3264678.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HYDROXYZINE HCL 50 MG/ML INTRAMUSCULAR SOLUTION", "code_information": [{"code": "J3410", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 58.22, "maximum": 167.62, "gross_charge": 120.05, "discounted_cash": 72.03, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 88.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 114.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 109.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 167.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 88.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 96.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 96.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 114.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 88.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 88.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 88.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 109.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 167.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 109.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 167.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 96.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "THIAMINE 500 MG/105 ML NS (PREMIX)", "code_information": [{"code": "J3411", "type": "HCPCS"}], "drug_information": {"unit": 105, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 20.71, "maximum": 58.35, "gross_charge": 42.7, "discounted_cash": 25.62, "payers_information": [{"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 38.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 58.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 38.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 58.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 30.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 38.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 58.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 30.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION", "code_information": [{"code": "J3411", "type": "HCPCS"}], "drug_information": {"unit": 2, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 9.85, "maximum": 23.34, "gross_charge": 20.3, "discounted_cash": 12.18, "payers_information": [{"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 12.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 15.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 23.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 12.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 15.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 15.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 23.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 23.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PYRIDOXINE (VITAMIN B6) 100 MG/ML INJECTION SOLUTION (PEDIATRICS)", "code_information": [{"code": "J3415", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 30.92, "maximum": 100.32, "gross_charge": 63.75, "discounted_cash": 38.25, "payers_information": [{"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 65.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 100.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 65.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 100.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 43.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 65.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 100.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 43.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PYRIDOXINE (VITAMIN B6) 100 MG/ML INJECTION SOLUTION", "code_information": [{"code": "J3415", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 30.92, "maximum": 100.32, "gross_charge": 63.75, "discounted_cash": 38.25, "payers_information": [{"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 65.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 100.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 43.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 65.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 100.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 65.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 100.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 43.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION", "code_information": [{"code": "J3420", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 2.71, "maximum": 6.33, "gross_charge": 7.45, "discounted_cash": 4.47, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HYDROXOCOBALAMIN 5 GRAM INTRAVENOUS SOLUTION", "code_information": [{"code": "J3424", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1087.8, "maximum": 3502.0, "gross_charge": 4312.35, "discounted_cash": 2587.41, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3160.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3502.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2130.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2311.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2371.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1087.8, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1087.8, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 2371.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1087.8, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3160.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2156.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1087.8, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3449.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1087.8, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3449.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3502.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1087.8, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2337.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3234.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3160.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3160.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3160.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2501.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3234.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1087.8, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1087.8, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2337.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1087.8, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3449.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1087.8, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1087.8, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1087.8, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2501.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HYDROXOCOBALAMIN 1,000 MCG/ML INTRAMUSCULAR SOLUTION", "code_information": [{"code": "J3425", "type": "HCPCS"}], "drug_information": {"unit": 30, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 69.91, "maximum": 193.41, "gross_charge": 144.15, "discounted_cash": 86.49, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 107.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 107.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 107.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 90.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 126.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 193.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 122.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 122.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 119.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 115.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 115.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 90.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 107.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 126.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 193.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 122.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 119.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 122.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 126.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 193.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 119.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 115.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 107.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION", "code_information": [{"code": "J3430", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 55.36, "maximum": 181.16, "gross_charge": 114.15, "discounted_cash": 68.49, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 96.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 118.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 181.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 97.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 97.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 96.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 118.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 181.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 97.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 118.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 181.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 97.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJECTION SOLUTION (SO)", "code_information": [{"code": "J3430", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "minimum": 9.6, "maximum": 106.97, "gross_charge": 125.85, "discounted_cash": 75.51, "payers_information": [{"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 9.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 95.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 18.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 9.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 18.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 95.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 95.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 18.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "VORICONAZOLE 200 MG INTRAVENOUS POWDER FOR SOLUTION", "code_information": [{"code": "J3465", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 34.75, "maximum": 96.71, "gross_charge": 71.65, "discounted_cash": 42.99, "payers_information": [{"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 52.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 63.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 96.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 52.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 63.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 96.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 63.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 96.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HYALURONIDASE, HUMAN RECOMBINANT 150 UNIT/ML INJECTION SOLUTION", "code_information": [{"code": "J3473", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 119.55, "maximum": 348.14, "gross_charge": 246.5, "discounted_cash": 147.9, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 180.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 183.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 183.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 184.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 183.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 183.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 134.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 121.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 132.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 228.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 348.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 209.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 209.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 135.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 203.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 134.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 160.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 146.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 135.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 180.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 123.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 186.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 160.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 119.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 184.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 134.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 184.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 197.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 150.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 197.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 183.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 133.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 133.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 184.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 160.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 180.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 180.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 180.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 183.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 142.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 228.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 348.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 209.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 203.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 184.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 186.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 209.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 186.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 160.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 228.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 348.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 203.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 184.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 184.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 133.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 134.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 197.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 183.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 184.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 142.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 184.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MAGNESIUM SULFATE 20 GRAM/500 ML (4 %) IN WATER INTRAVENOUS SOLUTION", "code_information": [{"code": "J3475", "type": "HCPCS"}], "drug_information": {"unit": 500, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 10.62, "maximum": 105.73, "gross_charge": 21.9, "discounted_cash": 13.14, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 69.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 105.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 69.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 105.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 67.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 69.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 105.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 67.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MAGNESIUM SULFATE 20 GRAM/500 ML (4 %) IN WATER INTRAVENOUS SOLUTION|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "J3475", "type": "HCPCS"}], "drug_information": {"unit": 500, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 12.05, "maximum": 12.05, "gross_charge": 21.9, "discounted_cash": 13.14, "payers_information": [{"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MAGNESIUM SULFATE 500 MG/ML (50 %) INJECTION SOLUTION", "code_information": [{"code": "J3475", "type": "HCPCS"}], "drug_information": {"unit": 2, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.32, "maximum": 5.82, "gross_charge": 6.85, "discounted_cash": 4.11, "payers_information": [{"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MAGNESIUM SULFATE 500 MG/ML (50 %) INJECTION SOLUTION|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "J3475", "type": "HCPCS"}], "drug_information": {"unit": 2, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.77, "maximum": 3.77, "gross_charge": 6.85, "discounted_cash": 4.11, "payers_information": [{"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJECTION SOLUTION (USE WITH TPN CALCULATOR)", "code_information": [{"code": "J3475", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 38.95, "maximum": 132.16, "gross_charge": 80.3, "discounted_cash": 48.18, "payers_information": [{"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 86.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 132.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 86.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 132.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 84.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 84.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 86.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 132.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJECTION SOLUTION (USE WITH TPN CALCULATOR)|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "J3475", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 44.17, "maximum": 44.17, "gross_charge": 80.3, "discounted_cash": 48.18, "payers_information": [{"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MAGNESIUM SULFATE IV SYRINGE 40 MG/ML (PEDIATRICS)", "code_information": [{"code": "J3475", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 6.76, "maximum": 21.55, "gross_charge": 25.35, "discounted_cash": 15.21, "payers_information": [{"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 10.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 10.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 10.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MAGNESIUM SULFATE IV SYRINGE 40 MG/ML (PEDIATRICS)|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "J3475", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 13.94, "maximum": 13.94, "gross_charge": 25.35, "discounted_cash": 15.21, "payers_information": [{"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "POTASSIUM CHLORIDE 20 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK", "code_information": [{"code": "J3480", "type": "HCPCS"}], "drug_information": {"unit": 100, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 5.08, "maximum": 12.75, "gross_charge": 15.0, "discounted_cash": 9.0, "payers_information": [{"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "POTASSIUM CHLORIDE 20 MEQ/50 ML IN STERILE WATER INTRAVENOUS PIGGYBACK - CENTRAL LINE ONLY", "code_information": [{"code": "J3480", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 5.08, "maximum": 11.69, "gross_charge": 13.75, "discounted_cash": 8.25, "payers_information": [{"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "POTASSIUM CHLORIDE 40 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK - CENTRAL LINE ONLY", "code_information": [{"code": "J3480", "type": "HCPCS"}], "drug_information": {"unit": 100, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 6.98, "maximum": 15.47, "gross_charge": 14.4, "discounted_cash": 8.64, "payers_information": [{"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 10.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 15.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 10.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 15.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 10.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 15.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "POTASSIUM CHLORIDE 20 MEQ/L-LACTATED RINGERS-5 % DEXTROSE INTRAVENOUS", "code_information": [{"code": "J3480", "type": "HCPCS"}], "drug_information": {"unit": 1000, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 5.08, "maximum": 15.94, "gross_charge": 18.75, "discounted_cash": 11.25, "payers_information": [{"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "POTASSIUM CHLORIDE IV SYRINGE 0.4 MEQ/ML", "code_information": [{"code": "J3480", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 5.08, "maximum": 25.5, "gross_charge": 30.0, "discounted_cash": 18.0, "payers_information": [{"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "POTASSIUM CHLORIDE 2 MEQ/ML INTRAVENOUS SOLUTION (USE WITH TPN CALCULATOR)", "code_information": [{"code": "J3480", "type": "HCPCS"}], "drug_information": {"unit": 250, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 70.93, "maximum": 193.41, "gross_charge": 146.25, "discounted_cash": 87.75, "payers_information": [{"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 109.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 109.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 117.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 109.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 109.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 142.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 107.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 109.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 109.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 117.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 109.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 110.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 95.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 107.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 126.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 193.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 124.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 124.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 95.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 126.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 193.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 110.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 95.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 124.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 110.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 109.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 107.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 107.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 126.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 193.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 124.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 107.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 109.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 95.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 109.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 117.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 142.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "POTASSIUM CHLORIDE 2 MEQ/ML INTRAVENOUS SOLUTION", "code_information": [{"code": "J3480", "type": "HCPCS"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 5.08, "maximum": 11.52, "gross_charge": 13.55, "discounted_cash": 8.13, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "POTASSIUM CHLORIDE 20 MEQ/L IN D5-0.9 % SODIUM CHLORIDE INTRAVENOUS", "code_information": [{"code": "J3480", "type": "HCPCS"}], "drug_information": {"unit": 1000, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 5.08, "maximum": 10.63, "gross_charge": 12.5, "discounted_cash": 7.5, "payers_information": [{"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.2 % SODIUM CHLORIDE IV", "code_information": [{"code": "J3480", "type": "HCPCS"}], "drug_information": {"unit": 1000, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 5.08, "maximum": 15.94, "gross_charge": 18.75, "discounted_cash": 11.25, "payers_information": [{"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV", "code_information": [{"code": "J3480", "type": "HCPCS"}], "drug_information": {"unit": 1000, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 5.08, "maximum": 10.63, "gross_charge": 12.5, "discounted_cash": 7.5, "payers_information": [{"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ZIDOVUDINE 10 MG/ML INTRAVENOUS SOLUTION", "code_information": [{"code": "J3485", "type": "HCPCS"}], "drug_information": {"unit": 20, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 30.26, "maximum": 122.84, "gross_charge": 153.55, "discounted_cash": 92.13, "payers_information": [{"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 30.26, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 30.26, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 102.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 30.26, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 30.26, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 30.26, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 122.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 102.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 30.26, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 30.26, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 30.26, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 30.26, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 30.26, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 30.26, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 30.26, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ZIDOVUDINE IV SYRINGE 4 MG/ML (PEDIATRICS)", "code_information": [{"code": "J3485", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 30.26, "maximum": 116.88, "gross_charge": 146.1, "discounted_cash": 87.66, "payers_information": [{"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 30.26, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 30.26, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 30.26, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 30.26, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 30.26, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 30.26, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 30.26, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 116.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 102.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 30.26, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 30.26, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 30.26, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 102.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 30.26, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 30.26, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ZIPRASIDONE 20 MG/ML (FINAL CONCENTRATION) INTRAMUSCULAR SOLUTION", "code_information": [{"code": "J3486", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 21.22, "maximum": 117.98, "gross_charge": 71.75, "discounted_cash": 43.05, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 21.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 77.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 117.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 21.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 77.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 117.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 77.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 117.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ZOLEDRONIC ACID 4 MG/5 ML INTRAVENOUS SOLUTION", "code_information": [{"code": "J3489", "type": "HCPCS"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 70.32, "maximum": 155.3, "gross_charge": 182.7, "discounted_cash": 109.62, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 133.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 135.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 135.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 137.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 135.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 70.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 97.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 85.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 131.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 155.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 155.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 150.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 135.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 126.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 118.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 133.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 105.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 137.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 118.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 88.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 137.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 137.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 146.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 137.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 146.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 70.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 137.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 118.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 133.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 133.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 133.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 135.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 85.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 131.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 155.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 150.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 137.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 137.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 155.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 137.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 118.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 85.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 131.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 150.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 137.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 137.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 146.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 135.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 137.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 137.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MVI,ADULT NO.4 WITH VIT K 3300 UNIT-150 MCG/10 ML INTRAVENOUS SOLUTION", "code_information": [{"code": "J3490", "type": "HCPCS"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 7.32, "maximum": 12.84, "gross_charge": 15.1, "discounted_cash": 9.06, "payers_information": [{"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION (SO)", "code_information": [{"code": "J3490", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 24.1, "maximum": 42.25, "gross_charge": 49.7, "discounted_cash": 29.82, "payers_information": [{"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DEXTRAN 40 10 % IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION", "code_information": [{"code": "J7100", "type": "HCPCS"}], "drug_information": {"unit": 500, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 184.24, "maximum": 269.99, "gross_charge": 317.65, "discounted_cash": 190.59, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 254.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 269.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 184.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 184.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 269.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DEXTRAN 40 10 % IN 0.9 % SODIUM CHLORIDE IVPB", "code_information": [{"code": "J7100", "type": "HCPCS"}], "drug_information": {"unit": 500, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 184.24, "maximum": 269.99, "gross_charge": 317.65, "discounted_cash": 190.59, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 269.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 184.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 184.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 254.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 269.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DEXTRAN 40 10 % IN 5 % DEXTROSE IVPB", "code_information": [{"code": "J7100", "type": "HCPCS"}], "drug_information": {"unit": 500, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 99.7, "maximum": 269.99, "gross_charge": 171.9, "discounted_cash": 103.14, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 137.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 269.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 269.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DEXTRAN 40 10 % IN 5 % DEXTROSE INTRAVENOUS", "code_information": [{"code": "J7100", "type": "HCPCS"}], "drug_information": {"unit": 500, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 99.7, "maximum": 269.99, "gross_charge": 171.9, "discounted_cash": 103.14, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 137.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 269.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 269.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HUMAN PROTHROMBIN COMPLEX,4-FACTOR 500 UNIT (400-620 UNIT) IV SOLUTION", "code_information": [{"code": "J7168", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 2.09, "maximum": 19.21, "gross_charge": 9.7, "discounted_cash": 5.82, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 12.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 19.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2.09, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2.09, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2.09, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2.09, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2.09, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2.09, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 12.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 19.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 12.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 19.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2.09, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2.09, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2.09, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2.09, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2.09, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2.09, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FIBRINOGEN 1 GRAM (700 MG-1,300 MG) INTRAVENOUS SOLUTION", "code_information": [{"code": "J7177", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ME"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.23, "maximum": 4.09, "gross_charge": 4.1, "discounted_cash": 2.46, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.23, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ANTIHEMOPHILIC FACTOR VIII,REC B-DOMAIN DELETED 250 (+/-) UNIT IV SOLN", "code_information": [{"code": "J7185", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.59, "maximum": 10.25, "gross_charge": 3.75, "discounted_cash": 2.25, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 10.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.59, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.59, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.59, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 10.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.59, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 10.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ANTIHEMOPHILIC FACTOR VIII,REC B-DOMAIN DELETED 500 (+/-) UNIT IV SOLN", "code_information": [{"code": "J7185", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.59, "maximum": 10.25, "gross_charge": 3.75, "discounted_cash": 2.25, "payers_information": [{"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 10.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.59, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 10.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.59, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.59, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.59, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 10.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ANTIHEMOPHILIC FACTOR VIII,REC B-DOMAIN DELET 1,000 (+/-) UNIT IV SOLN", "code_information": [{"code": "J7185", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.59, "maximum": 10.25, "gross_charge": 3.75, "discounted_cash": 2.25, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 10.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.59, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.59, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.59, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 10.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.59, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 10.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ANTIHEMOPHILIC FACTOR VIII,REC B-DOMAIN DELET 2,000 (+/-) UNIT IV SOLN", "code_information": [{"code": "J7185", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.59, "maximum": 10.25, "gross_charge": 3.75, "discounted_cash": 2.25, "payers_information": [{"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 10.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.59, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 10.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.59, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.59, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.59, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 10.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ANTIHEMOPHILIC FACTOR-VWF 250 UNIT-600 UNIT (VWF DOSING) INTRAVENOUS SOLUTION", "code_information": [{"code": "J7187", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.49, "maximum": 9.61, "gross_charge": 5.25, "discounted_cash": 3.15, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.49, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.49, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 9.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.49, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.49, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.49, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.49, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 9.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 9.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.49, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.49, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.49, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.49, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.49, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.49, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ANTIHEMOPHILIC FACTOR-VWF 500 UNIT-1,200 UNIT (VWF DOSING) INTRAVENOUS SOLUTION", "code_information": [{"code": "J7187", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.49, "maximum": 9.61, "gross_charge": 5.25, "discounted_cash": 3.15, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.49, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.49, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.49, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.49, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.49, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.49, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 9.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 9.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.49, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.49, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.49, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.49, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 9.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.49, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.49, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ANTIHEMOPHILIC FACTOR-VWF 1,000 UNIT-2,400 UNIT (VWF DOSING) INTRAVENOUS SOLUTION", "code_information": [{"code": "J7187", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.49, "maximum": 9.61, "gross_charge": 5.25, "discounted_cash": 3.15, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.49, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.49, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 9.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.49, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.49, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.49, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.49, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 9.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 9.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.49, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.49, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.49, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.49, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.49, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.49, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "COAGULATION FACTOR VIIA RECOMB 1 MG (1,000 MCG) INTRAVENOUS SOLUTION", "code_information": [{"code": "J7189", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 2622.0, "maximum": 16891.14, "gross_charge": 10626.3, "discounted_cash": 6375.78, "payers_information": [{"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11082.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 16891.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 9032.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8777.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7969.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7969.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8501.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5801.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7969.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8501.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8960.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5759.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5759.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 7969.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6907.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2622.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7789.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7789.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7895.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6163.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7789.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5695.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11082.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 16891.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 9032.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 9032.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5844.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8777.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 7863.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 7385.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 6907.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5801.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7789.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3542.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8022.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6907.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5153.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7789.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 7895.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7895.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 7969.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7895.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8960.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5801.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5493.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5249.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7969.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8022.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8022.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6907.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11082.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 16891.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8777.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9032.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 7969.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2622.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2622.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7969.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5759.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5801.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2622.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8501.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7895.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7969.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6163.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7969.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "COAGULATION FACTOR VIIA RECOMB 5 MG (5,000 MCG) INTRAVENOUS SOLUTION", "code_information": [{"code": "J7189", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 13110.0, "maximum": 84455.7, "gross_charge": 53131.2, "discounted_cash": 31878.72, "payers_information": [{"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39848.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 30816.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39848.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 39476.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42504.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 13110.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29009.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28797.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39848.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 13110.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 13110.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 39848.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45161.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 55413.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 84455.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43886.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40114.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34535.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40114.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39848.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43886.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29009.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27468.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26246.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 39476.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 44800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38945.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 39476.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 39476.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 39848.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40114.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34535.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25768.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 17710.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38945.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29009.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 39317.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 36926.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 34535.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 55413.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 84455.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 45161.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 45161.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 29222.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43886.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28478.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38945.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38945.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 39476.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 30816.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38945.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 13110.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 39848.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34535.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28797.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28797.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39848.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42504.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 44800.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29009.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39848.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42504.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39848.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 55413.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 84455.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 45161.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "COAGULATION FACTOR IX (RECOMB) 250 UNIT INTRAVENOUS SOLUTION", "code_information": [{"code": "J7195", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.83, "maximum": 11.8, "gross_charge": 4.5, "discounted_cash": 2.7, "payers_information": [{"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 11.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.83, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.83, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.83, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.83, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.83, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.83, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 11.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 11.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.83, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.83, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.83, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.83, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.83, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.83, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "COAGULATION FACTOR IX (RECOMB) 500 UNIT INTRAVENOUS SOLUTION", "code_information": [{"code": "J7195", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.83, "maximum": 11.8, "gross_charge": 4.5, "discounted_cash": 2.7, "payers_information": [{"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.83, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.83, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.83, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.83, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.83, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.83, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 11.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 11.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.83, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.83, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.83, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.83, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.83, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.83, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 11.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "COAGULATION FACTOR IX (RECOMB) 2,000 UNIT INTRAVENOUS SOLUTION", "code_information": [{"code": "J7195", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.83, "maximum": 11.8, "gross_charge": 4.5, "discounted_cash": 2.7, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 11.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.83, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.83, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.83, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.83, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.83, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.83, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 11.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 11.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.83, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.83, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.83, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.83, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.83, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1.83, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ANTITHROMBIN III (HUMAN) 500 (+/-) UNIT INTRAVENOUS SOLUTION (PEDIATRIC)", "code_information": [{"code": "J7197", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 4.05, "maximum": 13.82, "gross_charge": 16.35, "discounted_cash": 9.81, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 13.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 4.05, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 4.05, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 4.05, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 4.05, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 4.05, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 13.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 4.05, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 4.05, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 4.05, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 4.05, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 4.05, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 4.05, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 4.05, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FACTOR IX RECOMB, FC FUSION PROTEIN 500 UNIT INTRAVENOUS SOLUTION", "code_information": [{"code": "J7201", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.6, "maximum": 23.21, "gross_charge": 17.65, "discounted_cash": 10.59, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 12.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 15.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 23.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 12.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 15.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 23.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 15.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 23.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FACTOR IX RECOMB, FC FUSION PROTEIN 250 UNIT INTRAVENOUS SOLUTION", "code_information": [{"code": "J7201", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.6, "maximum": 23.21, "gross_charge": 17.65, "discounted_cash": 10.59, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 15.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 23.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 15.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 23.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 12.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 15.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 23.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 12.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LEVONORGESTREL 17.5 MCG/24 HR (UP TO 5 YRS) 19.5MG INTRAUTERINE DEVICE", "code_information": [{"code": "J7296", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 552.66, "maximum": 7830.72, "gross_charge": 3036.6, "discounted_cash": 1821.96, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2225.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 2256.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2256.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 2277.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2256.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4926.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1657.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1569.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1500.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1627.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5137.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 7830.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 2581.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 2581.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1670.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2508.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 625.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 552.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1657.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 1973.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1670.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 1670.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2225.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1518.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2292.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1973.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1472.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2277.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1657.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2277.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2429.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2429.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4926.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 710.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1645.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1645.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2277.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1973.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2225.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2225.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2225.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2256.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1761.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5137.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 7830.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 2581.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2508.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2277.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2292.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2581.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2292.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1973.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5137.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 7830.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2508.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2277.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 710.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 710.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2277.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1645.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1657.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 710.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2429.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2256.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2277.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1761.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2277.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LEVONORGESTREL 21 MCG/24 HR (UP TO 8 YEARS) 52 MG INTRAUTERINE DEVICE", "code_information": [{"code": "J7298", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 552.66, "maximum": 7830.72, "gross_charge": 3036.6, "discounted_cash": 1821.96, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2225.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 2256.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2256.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 2277.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2256.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4926.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1657.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1569.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1500.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1627.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5137.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 7830.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 2581.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 2581.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1670.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2508.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 625.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 552.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1657.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 1973.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1670.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 1670.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2225.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1518.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2292.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1973.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1472.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2277.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1657.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2277.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2429.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1852.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2429.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4926.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 710.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1645.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1645.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2277.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1973.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2225.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2225.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2225.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2256.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1761.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5137.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 7830.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 2581.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2508.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2277.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2292.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2581.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2292.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1973.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5137.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 7830.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2508.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2277.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 710.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 710.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2277.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1645.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1657.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 710.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2429.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2256.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2277.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1761.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2277.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LEVONORGESTREL 21 MCG/24 HR (UP TO 8 YEARS) 52 MG INTRAUTERINE DEVICE|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "J7298", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1973.79, "maximum": 2277.45, "gross_charge": 3036.6, "discounted_cash": 1821.96, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2277.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 2247.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 2110.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 1973.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ETONOGESTREL 68 MG SUBDERMAL IMPLANT", "code_information": [{"code": "J7307", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 999.61, "maximum": 7830.72, "gross_charge": 5492.35, "discounted_cash": 3295.41, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4025.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 4080.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4080.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 4119.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4080.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4926.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2998.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2839.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2713.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2943.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5137.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 7830.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4668.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4668.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3020.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4536.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1131.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 999.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2998.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 3570.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 3267.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 3020.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4025.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2746.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4146.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3570.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2663.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4119.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2998.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4119.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4393.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3350.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4393.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4926.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1285.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2976.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2976.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 4119.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3570.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4025.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4025.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4025.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4080.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3185.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5137.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 7830.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4668.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4536.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4119.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4146.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4668.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4146.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3570.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5137.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 7830.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4536.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 4119.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1285.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1285.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4119.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2976.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2998.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1285.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4393.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4080.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4119.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3185.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4119.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MITOMYCIN 0.2 MG OPHTHALMIC KIT", "code_information": [{"code": "J7315", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 827.05, "maximum": 2772.21, "gross_charge": 1705.25, "discounted_cash": 1023.15, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1249.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 1267.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1267.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 1278.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1267.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 931.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 881.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 842.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 914.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1818.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 2772.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1449.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 1449.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 937.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1408.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 931.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 1261.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1185.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 1108.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1249.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 852.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1287.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1108.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 827.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1278.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 931.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1278.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1364.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1278.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1364.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 924.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 924.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1278.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1108.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1249.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1249.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1249.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1267.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 989.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1818.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 2772.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 1449.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1408.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1278.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1287.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1449.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1287.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1108.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1818.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 2772.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1408.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1278.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1278.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 924.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 931.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1364.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1267.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1278.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 989.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1278.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "AZATHIOPRINE ORAL SUSPENSION 50 MG/ML", "code_information": [{"code": "J7500", "type": "HCPCS"}], "drug_information": {"unit": 60, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 15.23, "maximum": 433.8, "gross_charge": 102.7, "discounted_cash": 61.62, "payers_information": [{"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 15.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 23.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 433.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 15.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 23.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 433.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 15.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 23.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "AZATHIOPRINE 50 MG TABLET", "code_information": [{"code": "J7500", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.25, "maximum": 7.23, "gross_charge": 2.25, "discounted_cash": 1.35, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "AZATHIOPRINE 100 MG SOLUTION FOR INJECTION", "code_information": [{"code": "J7501", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 253.53, "maximum": 864.12, "gross_charge": 1080.15, "discounted_cash": 648.09, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 791.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 760.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 533.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 578.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 594.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 253.53, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 253.53, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 594.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 253.53, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 791.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 540.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 253.53, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 864.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 253.53, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 864.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 760.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 253.53, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 585.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 810.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 791.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 791.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 791.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 626.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 810.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 253.53, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 253.53, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 585.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 253.53, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 864.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 253.53, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 253.53, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 253.53, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 626.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CYCLOSPORINE MODIFIED 100 MG CAPSULE", "code_information": [{"code": "J7502", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.69, "maximum": 11.67, "gross_charge": 7.6, "discounted_cash": 4.56, "payers_information": [{"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 11.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 11.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 11.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CYCLOSPORINE MODIFIED 100 MG/ML ORAL SOLUTION", "code_information": [{"code": "J7502", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 190.82, "maximum": 583.45, "gross_charge": 393.45, "discounted_cash": 236.07, "payers_information": [{"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 297.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 255.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 334.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 297.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 295.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 288.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 288.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 292.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 228.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 382.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 583.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 334.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 288.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 214.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 295.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 255.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 213.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 213.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 295.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 314.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 350.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 295.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 314.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 295.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 196.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 297.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 255.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 190.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 288.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 214.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 291.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 273.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 255.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 210.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 382.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 583.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 334.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 334.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 216.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 214.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 203.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 194.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 292.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 350.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 288.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 292.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 292.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 295.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 295.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 292.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 314.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 214.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 213.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 295.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 295.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 382.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 583.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 228.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 295.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TACROLIMUS XR 0.75 MG TABLET,EXTENDED RELEASE 24 HR", "code_information": [{"code": "J7503", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 9.17, "maximum": 36.17, "gross_charge": 18.9, "discounted_cash": 11.34, "payers_information": [{"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 18.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 18.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 23.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 36.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 23.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 36.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 23.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 36.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TACROLIMUS XR 1 MG TABLET,EXTENDED RELEASE 24 HR", "code_information": [{"code": "J7503", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 12.2, "maximum": 48.22, "gross_charge": 25.15, "discounted_cash": 15.09, "payers_information": [{"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 31.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 48.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 31.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 48.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 31.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 48.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 24.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 24.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TACROLIMUS XR 4 MG TABLET,EXTENDED RELEASE 24 HR", "code_information": [{"code": "J7503", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 43.38, "maximum": 192.89, "gross_charge": 89.45, "discounted_cash": 53.67, "payers_information": [{"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 99.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 99.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 126.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 192.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 126.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 192.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 126.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 192.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LYMPHOCYTE,ANTI-THYMO IMMUNE GLOBULIN 50 MG/ML INTRAVENOUS SOLUTION", "code_information": [{"code": "J7504", "type": "HCPCS"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 5307.93, "maximum": 17582.84, "gross_charge": 21978.55, "discounted_cash": 13187.13, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16110.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 16944.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10857.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11780.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5307.93, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5307.93, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 12088.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 12088.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5307.93, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16110.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10989.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5307.93, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17582.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5307.93, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17582.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 16944.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5307.93, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11912.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 16483.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16110.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16110.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 12747.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16110.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 16483.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5307.93, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5307.93, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11912.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5307.93, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17582.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5307.93, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5307.93, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5307.93, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 12747.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ANTITHYMOCYTE GLOBULIN (EQUINE) TEST DOSE", "code_information": [{"code": "J7504", "type": "HCPCS"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 5307.93, "maximum": 17582.84, "gross_charge": 21978.55, "discounted_cash": 13187.13, "payers_information": [{"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5307.93, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5307.93, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5307.93, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17582.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5307.93, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11912.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5307.93, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5307.93, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 12088.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 12088.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5307.93, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5307.93, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11780.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10857.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 16944.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16110.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 16483.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16110.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16110.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 12747.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16110.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 16483.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11912.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5307.93, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17582.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 16944.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5307.93, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17582.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5307.93, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10989.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16110.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5307.93, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 12747.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE", "code_information": [{"code": "J7507", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.51, "maximum": 2.04, "gross_charge": 2.4, "discounted_cash": 1.44, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TACROLIMUS 5 MG CAPSULE, IMMEDIATE-RELEASE", "code_information": [{"code": "J7507", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 2.55, "maximum": 11.22, "gross_charge": 13.2, "discounted_cash": 7.92, "payers_information": [{"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TACROLIMUS 0.5 MG CAPSULE, IMMEDIATE-RELEASE", "code_information": [{"code": "J7507", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.51, "maximum": 2.0, "gross_charge": 2.35, "discounted_cash": 1.41, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TACROLIMUS SUSPENSION 1 MG/ML", "code_information": [{"code": "J7507", "type": "HCPCS"}], "drug_information": {"unit": 120, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 61.2, "maximum": 234.94, "gross_charge": 276.4, "discounted_cash": 165.84, "payers_information": [{"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 207.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 160.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 207.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 205.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 221.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 150.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 149.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 207.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 207.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 234.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 202.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 205.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 205.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 207.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 101.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 154.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 234.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 234.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 152.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 228.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 150.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 142.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 205.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 61.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 101.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 154.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 228.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 208.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 179.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 208.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 207.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 202.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 205.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 160.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 101.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 154.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 234.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 228.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 202.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 202.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 207.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 179.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 149.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 149.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 207.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 221.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 61.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 207.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 221.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 150.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 207.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 208.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 179.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 134.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 138.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 202.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 204.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 192.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 179.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 150.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 148.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "METHYLPREDNISOLONE 8 MG TABLET", "code_information": [{"code": "J7509", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.18, "maximum": 4.51, "gross_charge": 5.3, "discounted_cash": 3.18, "payers_information": [{"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "METHYLPREDNISOLONE 16 MG TABLET", "code_information": [{"code": "J7509", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 2.37, "maximum": 4.68, "gross_charge": 5.5, "discounted_cash": 3.3, "payers_information": [{"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "METHYLPREDNISOLONE 4 MG TABLET", "code_information": [{"code": "J7509", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.59, "maximum": 3.44, "gross_charge": 4.05, "discounted_cash": 2.43, "payers_information": [{"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLUTION", "code_information": [{"code": "J7510", "type": "HCPCS"}], "drug_information": {"unit": 237, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 68.29, "maximum": 848.17, "gross_charge": 140.8, "discounted_cash": 84.48, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 130.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 119.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 556.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 848.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 116.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 97.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 130.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 556.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 848.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 119.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 119.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 116.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 556.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 848.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 119.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 116.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLUTION|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "J7510", "type": "HCPCS"}], "drug_information": {"unit": 237, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 129.22, "maximum": 842.24, "gross_charge": 140.8, "discounted_cash": 84.48, "payers_information": [{"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 552.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 842.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 552.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 842.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 129.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 552.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 842.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 129.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ANTI-THYMOCYTE GLOBULIN (RABBIT) 25 MG INTRAVENOUS SOLUTION (ROUNDS TO 25 MG)", "code_information": [{"code": "J7511", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1009.75, "maximum": 6509.86, "gross_charge": 5037.65, "discounted_cash": 3022.59, "payers_information": [{"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3742.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3778.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1009.75, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2921.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4271.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 6509.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4282.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4161.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3692.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3742.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2921.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3692.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3778.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3803.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4282.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3803.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3274.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4271.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 6509.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4161.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3778.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1009.75, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1009.75, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3778.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2730.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2750.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1009.75, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4030.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1009.75, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1009.75, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3778.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2700.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2750.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2604.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2488.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4271.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 6509.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4282.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4282.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2770.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4161.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1009.75, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1009.75, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 3727.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 3501.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 3274.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2750.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1009.75, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3692.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2518.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3803.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3274.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2443.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1009.75, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3778.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3778.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4030.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2750.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1009.75, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3778.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4030.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3367.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2730.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2730.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3778.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3274.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1009.75, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3692.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3692.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 3742.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3742.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 3778.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3742.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3367.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ANTI-THYMOCYTE GLOBULIN (RABBIT) 25 MG INTRAVENOUS SOLUTION (DOSES<125MG)", "code_information": [{"code": "J7511", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1009.75, "maximum": 4282.0, "gross_charge": 5037.65, "discounted_cash": 3022.59, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2921.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1009.75, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3778.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3742.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3778.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1009.75, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1009.75, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4030.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1009.75, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2750.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2730.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3778.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1009.75, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1009.75, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3778.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3067.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3304.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4161.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3803.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3274.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4282.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3803.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3778.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3979.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3979.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3742.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2921.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3067.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3304.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4282.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4161.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3753.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2750.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2604.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2488.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3067.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3304.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4282.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4282.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2770.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4161.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3526.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3979.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1009.75, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2750.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 3727.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 3501.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 3274.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1009.75, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1009.75, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3979.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1009.75, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3778.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3274.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2730.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2730.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3778.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4030.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3591.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1009.75, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2750.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3778.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4030.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3778.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1009.75, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3803.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3274.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2443.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3742.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3591.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3979.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 3742.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3742.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 3778.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PREDNISONE 1 MG TABLET", "code_information": [{"code": "J7512", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.04, "maximum": 4.77, "gross_charge": 0.55, "discounted_cash": 0.33, "payers_information": [{"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PREDNISONE 10 MG TABLET", "code_information": [{"code": "J7512", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.22, "maximum": 47.7, "gross_charge": 0.45, "discounted_cash": 0.27, "payers_information": [{"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 47.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 47.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PREDNISONE 20 MG TABLET", "code_information": [{"code": "J7512", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.27, "maximum": 95.4, "gross_charge": 0.55, "discounted_cash": 0.33, "payers_information": [{"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 95.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 95.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PREDNISONE 5 MG TABLET", "code_information": [{"code": "J7512", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.21, "maximum": 23.85, "gross_charge": 0.55, "discounted_cash": 0.33, "payers_information": [{"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 23.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 23.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PREDNISONE 50 MG TABLET", "code_information": [{"code": "J7512", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.56, "maximum": 238.5, "gross_charge": 1.15, "discounted_cash": 0.69, "payers_information": [{"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 238.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 238.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CYCLOSPORINE MODIFIED 25 MG CAPSULE", "code_information": [{"code": "J7515", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.9, "maximum": 3.42, "gross_charge": 1.85, "discounted_cash": 1.11, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MYCOPHENOLATE MOFETIL 250 MG CAPSULE", "code_information": [{"code": "J7517", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.54, "maximum": 1.53, "gross_charge": 1.8, "discounted_cash": 1.08, "payers_information": [{"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MYCOPHENOLATE MOFETIL 200 MG/ML ORAL POWDER FOR SUSPENSION", "code_information": [{"code": "J7517", "type": "HCPCS"}], "drug_information": {"unit": 160, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 69.12, "maximum": 634.78, "gross_charge": 746.8, "discounted_cash": 448.08, "payers_information": [{"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 560.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 554.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 597.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 407.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 404.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 560.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 560.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 81.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 123.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 616.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 563.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 485.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 634.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 563.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 560.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 547.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 547.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 554.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 433.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 81.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 123.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 634.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 616.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 547.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 407.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 560.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 485.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 404.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 404.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 560.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 597.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 69.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 560.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 597.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 560.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 373.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 547.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 554.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 554.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 560.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 81.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 123.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 634.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 634.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 410.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 616.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 407.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 386.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 368.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 554.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 69.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 563.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 485.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 362.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 547.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 407.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 552.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 519.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 485.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 400.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 433.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 560.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE", "code_information": [{"code": "J7518", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.25, "maximum": 11.09, "gross_charge": 13.05, "discounted_cash": 7.83, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SIROLIMUS 0.5 MG TABLET", "code_information": [{"code": "J7520", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.24, "maximum": 26.61, "gross_charge": 31.3, "discounted_cash": 18.78, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SIROLIMUS 1 MG/ML ORAL SOLUTION", "code_information": [{"code": "J7520", "type": "HCPCS"}], "drug_information": {"unit": 60, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 194.4, "maximum": 1169.3, "gross_charge": 1375.65, "discounted_cash": 825.39, "payers_information": [{"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 751.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 711.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 679.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1022.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 194.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1008.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 1022.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1022.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 1031.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1031.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 797.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1031.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1022.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1100.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 751.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 745.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1031.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1031.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1169.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1038.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 894.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 246.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 375.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1136.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1038.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1031.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1008.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1008.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 246.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 375.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 1169.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1136.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1008.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1022.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 797.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1031.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 894.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 745.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 745.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1031.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1100.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 194.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1031.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1100.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 751.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1031.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1038.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 894.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 667.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 687.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1008.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 751.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 737.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 1017.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 956.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 894.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 246.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 375.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1169.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 1169.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 756.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1136.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SIROLIMUS 1 MG TABLET", "code_information": [{"code": "J7520", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.24, "maximum": 24.27, "gross_charge": 28.55, "discounted_cash": 17.13, "payers_information": [{"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TACROLIMUS 5 MG/ML INTRAVENOUS SOLUTION", "code_information": [{"code": "J7525", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 262.45, "maximum": 1033.64, "gross_charge": 1292.05, "discounted_cash": 775.23, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 749.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1033.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 262.45, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 262.45, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 262.45, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 947.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 749.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 947.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 969.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 262.45, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 262.45, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 700.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 262.45, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 262.45, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 262.45, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 710.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 710.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 262.45, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 947.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 646.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 262.45, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1033.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 262.45, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1033.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 886.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 262.45, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 700.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 969.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 947.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 947.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 886.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 638.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 692.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TACROLIMUS IV SYRINGE 0.02 MG/ML (PEDIATRICS)", "code_information": [{"code": "J7525", "type": "HCPCS"}], "drug_information": {"unit": 250, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 262.45, "maximum": 886.34, "gross_charge": 1012.85, "discounted_cash": 607.71, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 587.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 262.45, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 262.45, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 262.45, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 810.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 262.45, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 548.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 262.45, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 262.45, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 759.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 742.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 742.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 587.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 742.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 759.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 548.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 262.45, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 810.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 886.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 262.45, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 810.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 262.45, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 506.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 742.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 262.45, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 557.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 557.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 262.45, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 262.45, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 542.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 500.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 886.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 742.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TACROLIMUS IVPB 0.02 MG/ML (PEDIATRICS)", "code_information": [{"code": "J7525", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 109.59, "maximum": 886.34, "gross_charge": 221.85, "discounted_cash": 133.11, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 162.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 886.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 109.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 118.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 262.45, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 262.45, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 122.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 122.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 262.45, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 162.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 110.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 262.45, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 177.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 262.45, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 177.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 886.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 262.45, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 166.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 162.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 162.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 128.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 162.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 166.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 262.45, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 262.45, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 262.45, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 177.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 262.45, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 262.45, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 262.45, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 128.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "EVEROLIMUS (IMMUNOSUPPRESSIVE) 0.25 MG TABLET", "code_information": [{"code": "J7527", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 4.99, "maximum": 36.0, "gross_charge": 42.35, "discounted_cash": 25.41, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "EVEROLIMUS (IMMUNOSUPPRESSIVE) 1 MG TABLET", "code_information": [{"code": "J7527", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 19.97, "maximum": 125.93, "gross_charge": 148.15, "discounted_cash": 88.89, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 111.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 110.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 118.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 111.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 111.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 19.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 30.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 122.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 111.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 96.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 125.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 111.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 111.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 110.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 110.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 110.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 111.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 109.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 96.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 111.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 96.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 19.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 30.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 125.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 125.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 122.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 110.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 26.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 19.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 30.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 125.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 122.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 111.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 96.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 111.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 118.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 26.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 111.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 118.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 111.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 111.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ACETYLCYSTEINE 200 MG/ML (20 %) SOLUTION", "code_information": [{"code": "J7608", "type": "HCPCS"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.89, "maximum": 47.4, "gross_charge": 59.25, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ACETYLCYSTEINE 200 MG/ML (20 %) SOLUTION", "code_information": [{"code": "J7608", "type": "HCPCS"}], "drug_information": {"unit": 30, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.89, "maximum": 47.4, "gross_charge": 37.75, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ACETYLCYSTEINE 200 MG/ML (20 %) SOLUTION", "code_information": [{"code": "J7608", "type": "HCPCS"}], "drug_information": {"unit": 4, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.89, "maximum": 47.4, "gross_charge": 21.4, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ACETYLCYSTEINE (RECTAL OR NG) SOLUTION 40 MG/ML", "code_information": [{"code": "J7608", "type": "HCPCS"}], "drug_information": {"unit": 150, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 6.44, "maximum": 180.3, "gross_charge": 35.4, "discounted_cash": 21.24, "payers_information": [{"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 180.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 180.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PHENYLEPHRINE 1 MG/10 ML (100 MCG/ML) IN 0.9 % SOD.CHLORIDE IV SYRINGE", "code_information": [{"code": "J7999", "type": "HCPCS"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 19.01, "maximum": 33.32, "gross_charge": 39.2, "discounted_cash": 23.52, "payers_information": [{"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LIDOCAINE 0.9% BUFFERED (5 ML) INJ SYRINGE", "code_information": [{"code": "J7999", "type": "HCPCS"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.8, "maximum": 1.4, "gross_charge": 1.65, "discounted_cash": 0.99, "payers_information": [{"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MORPHINE (PF) 1 MG/2 ML INTRAVENOUS SYRINGE", "code_information": [{"code": "J7999", "type": "HCPCS"}], "drug_information": {"unit": 2, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 17.99, "maximum": 31.54, "gross_charge": 37.1, "discounted_cash": 22.26, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MORPHINE (PF) 50 MG/50 ML (1 MG/ML) IN 0.9% SOD.CHLORIDE IV SYRINGE", "code_information": [{"code": "J7999", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 42.53, "maximum": 74.55, "gross_charge": 87.7, "discounted_cash": 52.62, "payers_information": [{"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MORPHINE (PF) 50 MG/50 ML (1 MG/ML) IN 0.9% SOD.CHLORIDE IV SYRINGE|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "J7999", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 48.24, "maximum": 57.01, "gross_charge": 87.7, "discounted_cash": 52.62, "payers_information": [{"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "EPINEPHRINE HCL 100 MCG/10 ML (10 MCG/ML) IN D5W INTRAVENOUS SYRINGE", "code_information": [{"code": "J7999", "type": "HCPCS"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 22.53, "maximum": 39.48, "gross_charge": 46.45, "discounted_cash": 27.87, "payers_information": [{"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "EPINEPHRINE HCL 100 MCG/10 ML (10 MCG/ML) IN D5W INTRAVENOUS SYRINGE|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "J7999", "type": "HCPCS"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 25.55, "maximum": 30.19, "gross_charge": 46.45, "discounted_cash": 27.87, "payers_information": [{"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MIDAZOLAM (PF) 50 MG/50 ML (1 MG/ML) IN SOD CHLOR,ISO-OSM IV SYRINGE", "code_information": [{"code": "J7999", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 58.56, "maximum": 102.64, "gross_charge": 120.75, "discounted_cash": 72.45, "payers_information": [{"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 88.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 88.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 96.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 88.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 88.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 88.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 96.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 96.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MIDAZOLAM (PF) INFUSION 1 MG/ML (SYRINGE) (PEDIATRICS)", "code_information": [{"code": "J7999", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 68.75, "maximum": 120.49, "gross_charge": 141.75, "discounted_cash": 85.05, "payers_information": [{"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 113.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 113.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 117.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 107.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 117.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 107.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 113.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 117.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 107.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MIDAZOLAM (PF) INFUSION 1 MG/ML (SYRINGE) (PEDIATRICS)|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "J7999", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 77.96, "maximum": 92.14, "gross_charge": 141.75, "discounted_cash": 85.05, "payers_information": [{"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HYDROMORPHONE 10 MG/50 ML (0.2 MG/ML) IN NS CARTRIDGE (PREMIX)", "code_information": [{"code": "J7999", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 125.49, "maximum": 219.94, "gross_charge": 258.75, "discounted_cash": 155.25, "payers_information": [{"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 141.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 194.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 207.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 141.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 140.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 194.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 194.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 219.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 195.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 168.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 157.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 169.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 213.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 195.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 194.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 189.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 189.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 157.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 169.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 219.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 213.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 189.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 192.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 150.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 194.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 168.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 140.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 140.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 194.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 207.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 194.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 207.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 194.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 150.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 194.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 192.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 191.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 179.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 168.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 141.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 133.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 195.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 168.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 125.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 129.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 189.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 141.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 138.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 157.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 169.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 219.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 219.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 142.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 213.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 189.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 192.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 192.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 194.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 192.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SUCCINYLCHOLINE CHLORIDE 100 MG/5 ML (20 MG/ML) IV SYRINGE (SO)", "code_information": [{"code": "J7999", "type": "HCPCS"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 49.08, "maximum": 86.02, "gross_charge": 101.2, "discounted_cash": 60.72, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SUCCINYLCHOLINE CHLORIDE 100 MG/5 ML (20 MG/ML) IV SYRINGE (SO)|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "J7999", "type": "HCPCS"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 55.66, "maximum": 65.78, "gross_charge": 101.2, "discounted_cash": 60.72, "payers_information": [{"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HYDROMORPHONE (PF) 10 MG/50 ML (0.2 MG/ML) IN 0.9% NACL IV SYRINGE (SO)", "code_information": [{"code": "J7999", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 39.04, "maximum": 68.43, "gross_charge": 80.5, "discounted_cash": 48.3, "payers_information": [{"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HYDROMORPHONE (PF) 10 MG/50 ML (0.2 MG/ML) IN 0.9% NACL IV SYRINGE (SO)|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "J7999", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 44.28, "maximum": 52.33, "gross_charge": 80.5, "discounted_cash": 48.3, "payers_information": [{"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MORPHINE (PF) 1 MG/2 ML INTRAVENOUS SYRINGE (PEDIATRICS)", "code_information": [{"code": "J7999", "type": "HCPCS"}], "drug_information": {"unit": 2, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 17.99, "maximum": 31.54, "gross_charge": 37.1, "discounted_cash": 22.26, "payers_information": [{"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "EPINEPHRINE HCL 100 MCG/10 ML (10 MCG/ML) IN D5W INTRAVENOUS SYRINGE (FOR ANESTHESIA OSM)", "code_information": [{"code": "J7999", "type": "HCPCS"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 22.53, "maximum": 39.48, "gross_charge": 46.45, "discounted_cash": 27.87, "payers_information": [{"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "EPINEPHRINE HCL 100 MCG/10 ML (10 MCG/ML) IN D5W INTRAVENOUS SYRINGE (FOR ANESTHESIA OSM)|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "J7999", "type": "HCPCS"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 25.55, "maximum": 30.19, "gross_charge": 46.45, "discounted_cash": 27.87, "payers_information": [{"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LIDOCAINE 4 % TOPICAL CREAM", "code_information": [{"code": "J8499", "type": "HCPCS"}], "drug_information": {"unit": 30, "type": "GR"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.75, "maximum": 16.48, "gross_charge": 20.6, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "APREPITANT 125 MG (25 MG/ML FINAL CONCENTRATION) ORAL SUSPENSION", "code_information": [{"code": "J8501", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 229.75, "maximum": 597.81, "gross_charge": 703.3, "discounted_cash": 421.98, "payers_information": [{"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 527.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 562.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 522.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 527.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 407.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 527.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 530.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 457.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 341.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 527.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 562.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 527.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 562.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 229.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 381.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 381.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 527.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 457.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 384.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 515.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 515.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 522.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 407.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 292.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 446.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 597.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 580.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 515.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 527.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 530.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 597.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 530.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 457.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 292.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 446.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 580.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 527.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 527.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 381.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 384.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 515.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 522.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 522.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 527.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 351.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 515.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 376.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 384.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 520.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 488.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 457.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 522.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 229.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 384.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 363.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 347.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 292.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 446.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 597.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 597.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 386.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 580.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "APREPITANT 80 MG CAPSULE", "code_information": [{"code": "J8501", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 147.04, "maximum": 285.73, "gross_charge": 314.45, "discounted_cash": 188.67, "payers_information": [{"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 235.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 182.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 235.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 233.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 251.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 171.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 170.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 235.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 235.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 187.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 285.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 259.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 237.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 204.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 267.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 237.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 235.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 230.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 187.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 285.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 267.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 259.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 230.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 233.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 182.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 230.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 171.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 235.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 204.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 170.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 170.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 235.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 251.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 147.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 235.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 251.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 237.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 204.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 152.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 235.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 230.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 233.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 233.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 235.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 157.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 230.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 232.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 218.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 204.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 171.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 168.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 187.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 285.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 267.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 267.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 172.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 259.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 171.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 162.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 155.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 233.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 147.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "APREPITANT 125 MG CAPSULE", "code_information": [{"code": "J8501", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 229.75, "maximum": 446.45, "gross_charge": 481.25, "discounted_cash": 288.75, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 357.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 229.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 262.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 248.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 237.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 292.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 446.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 409.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 409.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 264.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 397.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 257.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 262.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 356.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 334.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 312.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 352.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 352.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 357.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 357.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 360.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 360.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 363.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 312.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 233.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 360.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 385.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 360.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 385.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 229.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 260.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 260.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 360.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 312.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 262.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 352.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 352.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 357.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 279.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 292.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 446.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 409.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 397.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 352.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 360.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 363.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 409.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 363.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 312.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 292.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 446.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 397.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 360.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 360.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 260.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 262.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 385.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 357.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 360.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 279.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 360.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 240.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "APREPITANT ORAL SUSP 20 MG/ML", "code_information": [{"code": "J8501", "type": "HCPCS"}], "drug_information": {"unit": 25, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 840.24, "maximum": 1785.82, "gross_charge": 1732.45, "discounted_cash": 1039.47, "payers_information": [{"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1299.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1004.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1299.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1287.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1385.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 866.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1299.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1308.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1126.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 840.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1299.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1385.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 919.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1299.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1385.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1269.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1287.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1004.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1269.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 945.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1299.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1126.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 938.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 938.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 945.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 938.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1299.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1299.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1171.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1785.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1431.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1308.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1126.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1472.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1308.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1299.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1269.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1171.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1785.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 1472.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1431.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1269.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 1282.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1204.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 1126.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 945.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 928.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1171.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1785.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1472.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 1472.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 952.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1431.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 945.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 895.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 855.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1287.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 919.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1269.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 1287.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1287.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 1299.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CYCLOPHOSPHAMIDE 25 MG CAPSULE", "code_information": [{"code": "J8530", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.37, "maximum": 11.73, "gross_charge": 6.95, "discounted_cash": 4.17, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 11.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 11.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 11.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DEXAMETHASONE 1 MG/ML DROPS (CONCENTRATE)", "code_information": [{"code": "J8540", "type": "HCPCS"}], "drug_information": {"unit": 30, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 5.08, "maximum": 67.32, "gross_charge": 79.2, "discounted_cash": 47.52, "payers_information": [{"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DEXAMETHASONE 4 MG TABLET", "code_information": [{"code": "J8540", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.68, "maximum": 2.38, "gross_charge": 2.8, "discounted_cash": 1.68, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DEXAMETHASONE 0.5 MG/5 ML ORAL LIQ (SO)", "code_information": [{"code": "J8540", "type": "HCPCS"}], "drug_information": {"unit": 240, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 4.06, "maximum": 83.85, "gross_charge": 98.65, "discounted_cash": 59.19, "payers_information": [{"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "METHOTREXATE 2.5 MG/ML ORAL SOLUTION", "code_information": [{"code": "J8612", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 22.43, "maximum": 144.61, "gross_charge": 47.65, "discounted_cash": 28.59, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 76.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 94.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 144.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 22.43, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 22.43, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 22.43, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 22.43, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 22.43, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 76.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 22.43, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 94.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 144.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 94.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 144.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 22.43, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 22.43, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 22.43, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 22.43, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 22.43, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 22.43, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TEMOZOLOMIDE 5 MG CAPSULE", "code_information": [{"code": "J8700", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.22, "maximum": 9.22, "gross_charge": 10.85, "discounted_cash": 6.51, "payers_information": [{"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TEMOZOLOMIDE 20 MG CAPSULE", "code_information": [{"code": "J8700", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 4.88, "maximum": 16.24, "gross_charge": 19.1, "discounted_cash": 11.46, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 9.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 13.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 9.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 13.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 9.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 13.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TEMOZOLOMIDE 100 MG CAPSULE", "code_information": [{"code": "J8700", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 24.4, "maximum": 77.69, "gross_charge": 91.4, "discounted_cash": 54.84, "payers_information": [{"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 45.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 69.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 24.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 45.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 69.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 24.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 45.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 69.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TEMOZOLOMIDE SUSPENSION 10 MG/ML", "code_information": [{"code": "J8700", "type": "HCPCS"}], "drug_information": {"unit": 100, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 244.0, "maximum": 696.28, "gross_charge": 674.25, "discounted_cash": 404.55, "payers_information": [{"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 509.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 438.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 509.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 505.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 456.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 696.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 573.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 556.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 494.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 500.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 391.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 494.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 494.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 505.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 438.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 365.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 365.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 505.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 539.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 244.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 505.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 539.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 368.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 505.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 509.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 438.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 327.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 337.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 494.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 498.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 468.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 438.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 368.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 361.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 368.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 348.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 333.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 539.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 368.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 365.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 505.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 505.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 573.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 456.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 696.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 556.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 505.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 391.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 505.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 500.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 494.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 500.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 500.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 505.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 456.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 696.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 573.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 573.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 370.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 556.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 500.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 244.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DOXORUBICIN 50 MG/25 ML INTRAVENOUS SOLUTION", "code_information": [{"code": "J9000", "type": "HCPCS"}], "drug_information": {"unit": 25, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 45.95, "maximum": 156.4, "gross_charge": 184.0, "discounted_cash": 110.4, "payers_information": [{"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 138.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 119.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 134.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 134.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 134.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 58.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 89.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 156.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 151.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 138.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 138.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 156.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 138.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 119.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 58.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 89.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 151.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 138.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 138.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 147.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 138.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 138.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 134.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 138.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 119.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 138.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 138.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 147.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 138.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 147.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 45.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 134.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 138.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 45.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 95.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 58.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 89.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 156.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 156.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 151.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 119.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DOXORUBICIN 50 MG/25 ML INTRAVENOUS SOLUTION|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "J9000", "type": "HCPCS"}], "drug_information": {"unit": 25, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 101.2, "maximum": 119.6, "gross_charge": 184.0, "discounted_cash": 110.4, "payers_information": [{"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 119.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 109.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ALDESLEUKIN 22 MILLION UNIT INTRAVENOUS SOLUTION", "code_information": [{"code": "J9015", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 3338.87, "maximum": 39068.82, "gross_charge": 28425.2, "discounted_cash": 17055.12, "payers_information": [{"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 15633.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3338.87, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20835.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7327.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21461.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18476.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13786.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3338.87, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21318.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15520.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21318.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22740.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3338.87, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17339.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22740.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 17918.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3338.87, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15406.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15406.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 21318.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18476.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20835.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20835.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20835.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 21119.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 16486.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 25633.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 39068.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 24161.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23479.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21318.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21461.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24161.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21461.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18476.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 25633.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 39068.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23479.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 21318.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3338.87, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3338.87, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21318.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15406.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15520.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3338.87, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22740.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3338.87, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3338.87, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 21119.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21318.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3338.87, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 16486.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21318.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20835.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 21119.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 21119.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 21318.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 21119.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 17918.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15520.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14695.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14042.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15235.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 25633.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 39068.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 24161.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 24161.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 15633.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23479.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3338.87, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3338.87, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15520.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 18476.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 16912.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ARSENIC TRIOXIDE 1 MG/ML INTRAVENOUS SOLUTION", "code_information": [{"code": "J9017", "type": "HCPCS"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 127.82, "maximum": 476.43, "gross_charge": 263.55, "discounted_cash": 158.13, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 193.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 195.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 195.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 197.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 195.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 198.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 143.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 130.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 141.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 312.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 476.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 224.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 224.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 144.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 217.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 143.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 195.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 183.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 171.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 193.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 131.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 198.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 171.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 197.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 143.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 197.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 210.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 197.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 210.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 198.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 142.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 142.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 197.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 171.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 193.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 193.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 193.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 195.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 152.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 312.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 476.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 224.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 217.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 197.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 198.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 224.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 198.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 171.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 312.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 476.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 217.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 197.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 197.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 142.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 143.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 210.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 195.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 197.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 152.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 197.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ASPARAGINASE ERWINIA CHRYSANTHEMI-RYWN 10 MG/0.5 ML IM SOLUTION", "code_information": [{"code": "J9021", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "minimum": 5617.6, "maximum": 36219.25, "gross_charge": 24907.25, "discounted_cash": 14944.35, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18257.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 18506.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 18506.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 18680.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 18506.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 18691.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13599.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12877.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12304.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13350.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 23764.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 36219.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 21171.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 21171.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 13698.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20573.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5617.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5617.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13599.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 18431.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 17310.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 16189.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5617.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18257.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12453.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18804.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16189.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12080.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5617.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18680.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13599.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18680.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19925.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5617.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18680.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19925.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 18691.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5617.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13499.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13499.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 18680.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16189.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18257.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18257.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18257.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 18506.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 14446.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 23764.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 36219.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 21171.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20573.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18680.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18804.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21171.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18804.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16189.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 23764.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 36219.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20573.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 18680.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5617.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5617.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18680.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13499.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13599.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5617.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19925.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5617.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5617.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 18506.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18680.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5617.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 14446.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18680.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CLOFARABINE 1 MG/ML INTRAVENOUS SOLUTION", "code_information": [{"code": "J9027", "type": "HCPCS"}], "drug_information": {"unit": 20, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 287.38, "maximum": 2508.0, "gross_charge": 682.3, "discounted_cash": 409.38, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 500.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 995.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 337.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 365.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 375.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 287.38, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 287.38, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 375.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 287.38, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 500.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2508.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 287.38, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 545.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 287.38, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 545.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 995.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 287.38, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 369.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 511.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 500.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 500.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 500.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 395.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 511.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 287.38, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 287.38, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 369.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 287.38, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 545.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 287.38, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 287.38, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 287.38, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 395.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "BENDAMUSTINE 25 MG INTRAVENOUS POWDER FOR SOLUTION", "code_information": [{"code": "J9033", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 51.18, "maximum": 2724.44, "gross_charge": 3405.55, "discounted_cash": 2043.33, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2496.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 156.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1682.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1825.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1873.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 51.18, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 51.18, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1873.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 51.18, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2496.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 528.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 51.18, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2724.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2724.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 156.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 51.18, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 51.18, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1845.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2554.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2496.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2496.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2496.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1975.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2554.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 51.18, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 51.18, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1845.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 51.18, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2724.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 51.18, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 51.18, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 51.18, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1975.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "BENDAMUSTINE 100 MG INTRAVENOUS POWDER FOR SOLUTION", "code_information": [{"code": "J9033", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 204.7, "maximum": 10897.64, "gross_charge": 13622.05, "discounted_cash": 8173.23, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9984.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 204.7, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 7492.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 204.7, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 204.7, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7492.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7301.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6729.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 625.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 204.7, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 10216.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9984.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 7900.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9984.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9984.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 10216.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7383.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 204.7, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 204.7, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10897.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 625.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10897.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 204.7, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2112.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9984.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 7900.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 204.7, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 204.7, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 204.7, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10897.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 204.7, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7383.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 204.7, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "BENDAMUSTINE 25 MG/ML INTRAVENOUS SOLUTION", "code_information": [{"code": "J9034", "type": "HCPCS"}], "drug_information": {"unit": 4, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 1283.4, "maximum": 8271.5, "gross_charge": 6576.85, "discounted_cash": 3946.11, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4820.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 4886.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4886.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 4932.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4886.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4435.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3590.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3400.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3248.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3525.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5427.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 8271.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 5590.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5590.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3617.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5432.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1283.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1283.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3590.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 4274.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 3913.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 3617.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1283.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4820.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3265.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4965.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4274.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3189.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1283.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4932.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3590.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4932.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5261.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1283.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4011.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5261.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4435.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1283.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3564.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3564.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 4932.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4274.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4820.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4820.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4820.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4886.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3814.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5427.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 8271.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5590.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5432.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4932.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4965.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5590.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4965.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4274.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5427.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 8271.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5432.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 4932.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1283.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1283.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4932.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3564.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3590.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1283.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5261.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1283.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1283.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4886.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4932.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1283.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3814.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4932.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "BEVACIZUMAB 100MG/4ML (25 MG/ML) INTRAVENOUS SOLUTION", "code_information": [{"code": "J9035", "type": "HCPCS"}], "drug_information": {"unit": 4, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 736.32, "maximum": 4746.93, "gross_charge": 3306.25, "discounted_cash": 1983.75, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2423.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 2456.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2456.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 2479.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2456.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2469.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1805.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1709.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1633.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1772.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3114.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 4746.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 2810.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 2810.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1818.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2730.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 736.32, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 736.32, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1805.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 2149.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1967.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 1818.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 736.32, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2423.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1653.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2496.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2149.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1603.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 736.32, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2479.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1805.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2479.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2645.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 736.32, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2016.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2645.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2469.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 736.32, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1791.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1791.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2479.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2149.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2423.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2423.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2423.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2456.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1917.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3114.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 4746.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 2810.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2730.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2479.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2496.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2810.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2496.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2149.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3114.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 4746.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2730.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2479.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 736.32, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 736.32, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2479.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1791.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1805.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 736.32, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2645.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 736.32, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 736.32, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2456.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2479.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 736.32, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1917.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2479.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "AXATILIMAB-CSFR 50 MG/ML INTRAVENOUS SOLUTION", "code_information": [{"code": "J9038", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "minimum": 5008.5, "maximum": 78930.62, "gross_charge": 20996.75, "discounted_cash": 12598.05, "payers_information": [{"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16797.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38494.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41060.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5008.5, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 12243.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12808.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16797.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 16451.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31308.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41060.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 40213.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5008.5, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 12243.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11380.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11380.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27818.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27818.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 15747.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13647.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 38494.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33361.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15390.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37621.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15390.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37621.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15390.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 15600.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 12178.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37621.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 38134.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 29768.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 21185.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 32289.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 17847.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17343.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 51787.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 78930.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 43626.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42394.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15747.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38494.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15852.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38750.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17847.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43626.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15852.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13647.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38750.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33361.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 21185.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 32289.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17343.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 51787.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 78930.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42394.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 15747.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 38494.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5008.5, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 12243.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5008.5, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 12243.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15747.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38494.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11380.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27818.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11464.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28023.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5008.5, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 12243.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16797.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41060.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5008.5, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 12243.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5008.5, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 12243.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 15600.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 38134.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15747.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38494.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5008.5, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 12243.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 12178.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 29768.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15747.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38494.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15390.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 15600.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 15600.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 15747.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37621.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 38134.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 38134.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 38494.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 15600.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 16451.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 38134.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 40213.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11464.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10855.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10372.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28023.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26535.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25354.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11254.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27510.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 21185.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 32289.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 17847.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 17847.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 11548.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17343.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 51787.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 78930.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 43626.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 43626.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 28228.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42394.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5008.5, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5008.5, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 12243.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 12243.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11464.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28023.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 13647.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 12493.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 11548.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 33361.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 30538.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 28228.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5008.5, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 12243.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15390.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37621.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10498.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25662.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15852.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13647.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10183.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38750.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33361.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24892.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5008.5, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 12243.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15747.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38494.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11464.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28023.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15747.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "BLINATUMOMAB 35 MCG INTRAVENOUS KIT", "code_information": [{"code": "J9039", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 5728.91, "maximum": 36933.57, "gross_charge": 26064.8, "discounted_cash": 15638.88, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19105.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 19366.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 19366.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 19548.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 19366.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 19307.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14231.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13475.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12876.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13970.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 24232.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 36933.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 22155.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 22155.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 14335.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21529.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5728.91, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5728.91, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14231.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 19287.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 18115.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 16942.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5728.91, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19105.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6791.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19678.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16942.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12641.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5728.91, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19548.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14231.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19548.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20851.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5728.91, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19548.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20851.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 19307.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5728.91, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14127.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14127.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 19548.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16942.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19105.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19105.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19105.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 19366.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 15117.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 24232.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 36933.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 22155.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21529.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19548.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19678.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22155.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19678.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16942.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 24232.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 36933.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21529.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 19548.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5728.91, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5728.91, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19548.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14127.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14231.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5728.91, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20851.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5728.91, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5728.91, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 19366.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19548.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5728.91, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 15117.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19548.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "BLINATUMOMAB 35 MCG INTRAVENOUS KIT|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "J9039", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 14335.64, "maximum": 16942.12, "gross_charge": 26064.8, "discounted_cash": 15638.88, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15899.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 16942.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 15508.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 14335.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "BLEOMYCIN IV SYRINGE 3 UNITS/ML", "code_information": [{"code": "J9040", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 47.26, "maximum": 148.41, "gross_charge": 97.45, "discounted_cash": 58.47, "payers_information": [{"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 70.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 70.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 97.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 148.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 97.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 148.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 97.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 148.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "BLEOMYCIN IM/SC SYRINGE 3 UNIT/ML", "code_information": [{"code": "J9040", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 10.21, "maximum": 148.41, "gross_charge": 21.05, "discounted_cash": 12.63, "payers_information": [{"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 97.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 148.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 97.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 148.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 70.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 97.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 148.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 70.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "BLEOMYCIN IV SYRINGE 1 UNIT/ML (PEDIATRICS)", "code_information": [{"code": "J9040", "type": "HCPCS"}], "drug_information": {"unit": 15, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 51.02, "maximum": 148.41, "gross_charge": 105.2, "discounted_cash": 63.12, "payers_information": [{"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 97.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 148.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 97.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 148.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 70.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 70.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 97.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 148.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "BLEOMYCIN 15 UNIT SOLUTION FOR INJECTION", "code_information": [{"code": "J9040", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 47.26, "maximum": 148.41, "gross_charge": 97.45, "discounted_cash": 58.47, "payers_information": [{"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 97.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 148.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 97.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 148.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 70.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 97.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 148.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 70.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "BORTEZOMIB 3.5 MG INJECTION POWDER FOR SOLUTION", "code_information": [{"code": "J9041", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 47.41, "maximum": 604.73, "gross_charge": 97.75, "discounted_cash": 58.65, "payers_information": [{"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 396.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 604.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 187.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 233.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 187.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 396.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 604.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 396.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 604.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "BORTEZOMIB IV SYRINGE 1 MG/ML", "code_information": [{"code": "J9041", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 47.41, "maximum": 604.73, "gross_charge": 97.75, "discounted_cash": 58.65, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 396.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 604.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 396.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 604.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 187.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 233.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 187.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 396.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 604.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "BORTEZOMIB SUBCUTANEOUS SYRINGE 2.5 MG/ML", "code_information": [{"code": "J9041", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 47.41, "maximum": 604.73, "gross_charge": 97.75, "discounted_cash": 58.65, "payers_information": [{"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 396.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 604.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 187.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 233.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 187.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 396.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 604.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 396.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 604.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "BRENTUXIMAB VEDOTIN 50 MG INTRAVENOUS SOLUTION", "code_information": [{"code": "J9042", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 13422.55, "maximum": 86534.86, "gross_charge": 59457.5, "discounted_cash": 35674.5, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43582.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 44176.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 44176.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 44593.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 44176.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 43690.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32463.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30739.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29372.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31869.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 56777.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 86534.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 50538.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 50538.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 32701.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49111.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 13422.55, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 13422.55, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32463.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 43998.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 41322.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 38647.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 13422.55, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43582.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 15499.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44890.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38647.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28836.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 13422.55, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44593.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32463.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44593.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47566.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 13422.55, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44593.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47566.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 43690.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 13422.55, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32225.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32225.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 44593.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38647.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43582.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43582.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43582.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 44176.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 34485.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 56777.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 86534.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 50538.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49111.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44593.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44890.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50538.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44890.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38647.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 56777.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 86534.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49111.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 44593.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 13422.55, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 13422.55, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44593.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32225.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32463.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 13422.55, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47566.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 13422.55, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 13422.55, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 44176.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44593.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 13422.55, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 34485.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44593.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CARBOPLATIN 10 MG/ML INTRAVENOUS SOLUTION", "code_information": [{"code": "J9045", "type": "HCPCS"}], "drug_information": {"unit": 45, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 53.47, "maximum": 170.01, "gross_charge": 110.25, "discounted_cash": 66.15, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 64.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 111.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 170.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 88.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 88.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 64.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 111.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 170.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 111.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 170.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 88.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CARFILZOMIB 10 MG INTRAVENOUS SOLUTION", "code_information": [{"code": "J9047", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 556.07, "maximum": 3585.18, "gross_charge": 2765.35, "discounted_cash": 1659.21, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2027.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 2054.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2054.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 2074.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2054.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1862.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1509.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1429.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1366.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1482.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2352.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 3585.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 2350.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 2350.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1520.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2284.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 556.07, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 556.07, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1509.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 1797.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1645.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 1520.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 556.07, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2027.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 720.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2087.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1797.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1341.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 556.07, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2074.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1509.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2074.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2212.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 556.07, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1686.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2212.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1862.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 556.07, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1498.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1498.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2074.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1797.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2027.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2027.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2027.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2054.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1603.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2352.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 3585.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 2350.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2284.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2074.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2087.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2350.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2087.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1797.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2352.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 3585.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2284.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2074.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 556.07, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 556.07, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2074.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1498.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1509.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 556.07, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2212.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 556.07, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 556.07, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2054.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2074.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 556.07, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1603.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2074.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CARMUSTINE 100 MG INTRAVENOUS SOLUTION", "code_information": [{"code": "J9050", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 465.25, "maximum": 2999.4, "gross_charge": 1920.25, "discounted_cash": 1152.15, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1407.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 1426.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1426.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 1440.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1426.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 465.25, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 465.25, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1440.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 465.25, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 465.25, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1440.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1040.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1048.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 465.25, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1536.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 465.25, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1407.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1407.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1426.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1113.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1967.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 2999.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 1632.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1586.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1407.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1440.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1449.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1632.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1449.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1248.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1967.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 2999.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1586.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1029.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 465.25, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 465.25, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 1420.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1334.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 1248.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1048.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 465.25, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1426.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1173.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1048.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 992.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 948.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1967.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 2999.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1632.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 1632.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1056.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1586.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1407.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 960.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1449.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1248.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 931.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 465.25, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1440.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1440.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1536.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1048.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 465.25, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1440.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1536.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1173.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1040.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1040.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1440.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1248.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 465.25, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1113.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1440.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1440.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CARMUSTINE 100 MG INTRAVENOUS SOLUTION|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "J9050", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 232.62, "maximum": 1499.7, "gross_charge": 960.15, "discounted_cash": 576.09, "payers_information": [{"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 720.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 720.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 556.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 232.62, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 720.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 624.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 520.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 520.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 720.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 768.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 586.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 232.62, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 524.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 720.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 768.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 720.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 232.62, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 724.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 624.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 465.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 480.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 703.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 983.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1499.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 816.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 816.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 528.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 793.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 524.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 496.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 474.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 713.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 586.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 232.62, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 524.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 710.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 667.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 624.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 232.62, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 232.62, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 514.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 983.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1499.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 793.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 724.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 624.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 816.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 724.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 720.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 703.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 983.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1499.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 816.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 793.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 703.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 713.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 556.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 703.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 232.62, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 768.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 232.62, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 524.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 520.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 720.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 232.62, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 232.62, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 720.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 232.62, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 232.62, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 713.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 703.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 713.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 713.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 720.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CISPLATIN 1 MG/ML INTRAVENOUS SOLUTION", "code_information": [{"code": "J9060", "type": "HCPCS"}], "drug_information": {"unit": 100, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 65.9, "maximum": 144.67, "gross_charge": 170.2, "discounted_cash": 102.12, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 124.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 126.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 126.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 126.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 65.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 89.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 136.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 144.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 144.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 140.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 110.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 124.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 128.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 110.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 65.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 110.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 124.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 124.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 124.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 126.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 89.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 136.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 144.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 140.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 128.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 144.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 128.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 110.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 89.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 136.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 140.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 126.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CLADRIBINE 10 MG/10 ML INTRAVENOUS SOLUTION", "code_information": [{"code": "J9065", "type": "HCPCS"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 74.19, "maximum": 482.72, "gross_charge": 567.9, "discounted_cash": 340.74, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 416.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 421.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 421.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 425.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 421.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 328.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 310.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 293.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 280.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 304.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 313.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 478.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 482.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 482.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 312.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 469.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 74.19, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 74.19, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 310.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 369.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 337.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 312.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 74.19, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 416.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 283.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 428.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 369.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 275.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 74.19, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 425.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 310.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 425.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 454.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 74.19, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 346.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 454.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 328.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 74.19, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 307.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 307.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 425.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 369.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 416.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 416.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 416.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 421.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 329.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 313.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 478.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 482.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 469.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 425.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 428.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 482.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 428.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 369.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 313.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 478.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 469.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 425.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 74.19, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 74.19, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 425.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 307.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 310.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 74.19, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 454.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 74.19, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 74.19, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 421.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 425.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 74.19, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 329.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 425.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CYCLOPHOSPHAMIDE LIQUID 10 MG/ML", "code_information": [{"code": "J9070", "type": "HCPCS"}], "drug_information": {"unit": 100, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 60.93, "maximum": 284.58, "gross_charge": 334.8, "discounted_cash": 200.88, "payers_information": [{"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 251.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 251.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 181.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 182.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 267.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 248.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 251.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 194.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 251.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 264.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 248.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 248.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 251.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 248.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 238.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 182.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 173.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 165.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 249.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 203.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 219.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 284.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 284.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 184.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 276.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 182.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 217.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 184.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 184.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 264.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 234.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 252.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 217.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 162.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 251.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 182.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 251.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 267.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 204.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 267.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 238.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 181.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 181.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 251.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 217.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 264.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 264.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 264.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 248.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 194.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 203.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 219.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 284.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 276.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 251.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 252.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 284.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 252.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 217.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 203.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 219.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 276.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CYCLOPHOSPHAMIDE 1 GRAM INTRAVENOUS POWDER FOR SOLUTION (J9075)", "code_information": [{"code": "J9075", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 117.0, "maximum": 760.75, "gross_charge": 499.55, "discounted_cash": 299.73, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 366.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 371.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 371.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 374.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 371.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 420.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 272.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 258.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 246.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 267.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 499.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 760.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 424.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 424.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 274.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 412.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 117.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 117.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 272.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 369.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 347.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 117.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 366.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 249.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 377.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 242.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 117.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 374.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 272.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 374.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 399.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 117.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 374.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 399.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 420.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 117.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 270.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 270.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 374.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 366.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 366.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 366.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 371.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 289.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 499.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 760.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 424.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 412.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 374.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 377.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 424.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 377.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 499.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 760.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 412.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 374.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 117.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 117.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 374.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 270.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 272.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 117.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 399.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 117.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 117.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 371.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 374.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 117.0, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 289.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 374.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CYTARABINE (PF) 2 GRAM/20 ML (100 MG/ML) INJECTION SOLUTION", "code_information": [{"code": "J9100", "type": "HCPCS"}], "drug_information": {"unit": 20, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 34.51, "maximum": 108.31, "gross_charge": 71.15, "discounted_cash": 42.69, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 54.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 71.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 108.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 54.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 71.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 108.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 71.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 108.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CYTARABINE (PF) 2 GRAM/20 ML (100 MG/ML) INJECTION SOLUTION|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "J9100", "type": "HCPCS"}], "drug_information": {"unit": 20, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 39.13, "maximum": 46.25, "gross_charge": 71.15, "discounted_cash": 42.69, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CYTARABINE (PF) 100 MG/5 ML (20 MG/ML) INJECTION SOLUTION", "code_information": [{"code": "J9100", "type": "HCPCS"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 2.74, "maximum": 26.69, "gross_charge": 31.4, "discounted_cash": 18.84, "payers_information": [{"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CYTARABINE (PF) 100 MG/5 ML (20 MG/ML) INJECTION SOLUTION|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "J9100", "type": "HCPCS"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 17.27, "maximum": 20.41, "gross_charge": 31.4, "discounted_cash": 18.84, "payers_information": [{"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CALASPARGASE PEGOL-MKNL 750 UNIT/ML INTRAVENOUS SOLUTION", "code_information": [{"code": "J9118", "type": "HCPCS"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 30778.13, "maximum": 198438.66, "gross_charge": 128598.3, "discounted_cash": 77158.98, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 94262.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 95548.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 95548.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 96448.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 95548.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 103822.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 70214.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 66485.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 63527.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 68928.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 130199.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 198438.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 109308.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 109308.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 70729.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 106222.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 30778.13, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 30778.13, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 70214.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 95162.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 89375.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 83588.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 30778.13, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 94262.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 64299.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 97091.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 83588.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 62370.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 30778.13, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 96448.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 70214.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 96448.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 102878.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 30778.13, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 96448.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 102878.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 103822.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 30778.13, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 69700.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 69700.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 96448.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 83588.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 94262.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 94262.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 94262.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 95548.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 74587.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 130199.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 198438.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 109308.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 106222.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 96448.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 97091.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 109308.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 97091.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 83588.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 130199.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 198438.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 106222.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 96448.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 30778.13, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 30778.13, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 96448.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 69700.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 70214.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 30778.13, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 102878.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 30778.13, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 30778.13, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 95548.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 96448.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 30778.13, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 74587.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 96448.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DACTINOMYCIN 0.5 MG INTRAVENOUS SOLUTION", "code_information": [{"code": "J9120", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 307.99, "maximum": 1985.61, "gross_charge": 1693.95, "discounted_cash": 1016.37, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1241.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 1258.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1258.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 1270.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1258.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1023.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 924.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 875.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 836.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 907.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1302.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1985.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1439.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 1439.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 931.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1399.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 307.99, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 307.99, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 924.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 1101.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1007.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 931.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 307.99, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1241.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 846.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1278.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1101.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 821.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 307.99, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1270.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 924.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1270.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1355.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 307.99, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1033.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1355.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1023.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 307.99, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 918.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 918.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1270.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1101.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1241.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1241.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1241.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1258.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 982.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1302.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1985.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 1439.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1399.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1270.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1278.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1439.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1278.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1101.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1302.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1985.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1399.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1270.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 307.99, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 307.99, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1270.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 918.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 924.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 307.99, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1355.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 307.99, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 307.99, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1258.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1270.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 307.99, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 982.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1270.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DACARBAZINE 200 MG INTRAVENOUS SOLUTION", "code_information": [{"code": "J9130", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 25.82, "maximum": 57.33, "gross_charge": 67.45, "discounted_cash": 40.47, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 25.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 34.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 53.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 25.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 34.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 53.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 34.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 53.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DAUNORUBICIN 5 MG/ML INTRAVENOUS SOLUTION", "code_information": [{"code": "J9150", "type": "HCPCS"}], "drug_information": {"unit": 4, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 90.31, "maximum": 339.5, "gross_charge": 186.2, "discounted_cash": 111.72, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 138.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 138.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 139.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 138.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 133.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 222.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 339.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 158.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 158.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 153.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 96.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 139.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 148.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 138.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 139.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 139.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 137.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 129.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 121.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 140.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 121.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 139.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 139.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 148.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 139.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 148.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 133.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 139.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 121.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 138.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 222.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 339.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 158.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 153.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 139.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 140.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 140.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 121.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 222.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 339.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 153.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 158.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 139.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DAUNORUBICIN IV SYRINGE 5 MG/ML", "code_information": [{"code": "J9150", "type": "HCPCS"}], "drug_information": {"unit": 4, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 90.31, "maximum": 339.5, "gross_charge": 186.2, "discounted_cash": 111.72, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 138.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 133.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 96.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 222.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 339.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 158.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 158.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 153.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 138.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 138.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 139.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 139.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 158.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 222.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 339.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 153.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 140.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 121.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 140.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 139.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 222.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 339.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 158.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 153.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 138.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 139.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 121.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 139.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 148.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 133.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 139.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 148.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 139.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 140.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 121.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 137.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 129.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 121.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 139.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 139.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 138.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 148.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 139.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DAUNORUBICIN 44 MG AND CYTARABINE 100 MG IN LIPOSOME IV SOLUTION", "code_information": [{"code": "J9153", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 11461.56, "maximum": 41202.48, "gross_charge": 51503.1, "discounted_cash": 30901.86, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37751.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 37936.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25442.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27605.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 28326.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 11461.56, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 11461.56, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 28326.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 11461.56, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37751.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 13800.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 11461.56, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41202.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 11461.56, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41202.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 37936.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 11461.56, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27914.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 38627.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37751.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37751.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37751.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 29871.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 38627.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 11461.56, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 11461.56, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27914.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 11461.56, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41202.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 11461.56, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 11461.56, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 11461.56, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 29871.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DOCETAXEL 80 MG/8 ML (10 MG/ML) INTRAVENOUS SOLUTION", "code_information": [{"code": "J9171", "type": "HCPCS"}], "drug_information": {"unit": 8, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 89.26, "maximum": 335.24, "gross_charge": 184.05, "discounted_cash": 110.43, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 219.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 335.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 156.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 156.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 152.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 102.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 119.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 109.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 138.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 119.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 134.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 138.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 147.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 102.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 138.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 147.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 138.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 119.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 134.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 134.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 134.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 219.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 335.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 156.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 152.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 138.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 138.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 138.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 119.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 219.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 335.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 152.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 156.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 138.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 138.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 147.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 138.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 138.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 134.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 138.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 95.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DOCETAXEL 160 MG/16 ML (10 MG/ML) INTRAVENOUS SOLUTION", "code_information": [{"code": "J9171", "type": "HCPCS"}], "drug_information": {"unit": 16, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 204.8, "maximum": 1902.3, "gross_charge": 2238.0, "discounted_cash": 1342.8, "payers_information": [{"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1221.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1157.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1105.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1640.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 1662.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1662.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 1678.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1678.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1678.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1662.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1790.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1221.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1213.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1678.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1678.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1902.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 439.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 670.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1848.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1689.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1454.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1689.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1678.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 439.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 670.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 1902.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1848.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1640.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1662.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1298.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1640.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1640.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1678.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1454.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1213.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1213.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1678.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1790.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1365.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1790.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 204.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1221.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1678.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1119.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1640.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1689.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1454.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1085.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 1454.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1331.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 1230.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1221.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1199.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1662.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 204.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 439.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 670.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1902.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 1902.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1230.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1848.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1298.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DOCETAXEL 20 MG/2 ML (10 MG/ML) INTRAVENOUS SOLUTION", "code_information": [{"code": "J9171", "type": "HCPCS"}], "drug_information": {"unit": 2, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 25.6, "maximum": 299.29, "gross_charge": 352.1, "discounted_cash": 211.26, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 204.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 54.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 83.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 299.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 299.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 193.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 290.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 261.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 25.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 188.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 192.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 228.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 209.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 193.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 265.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 228.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 170.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 258.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 176.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 264.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 192.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 214.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 281.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 25.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 264.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 281.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 190.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 190.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 264.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 228.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 258.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 258.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 258.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 261.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 204.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 54.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 83.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 299.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 290.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 264.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 265.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 265.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 228.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 54.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 83.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 290.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 299.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 264.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 264.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 190.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 192.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 281.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 261.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 264.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 264.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 258.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 261.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 261.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 264.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 192.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 182.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 173.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "EPIRUBICIN IV SYRINGE 2 MG/ML", "code_information": [{"code": "J9178", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 102.85, "maximum": 635.03, "gross_charge": 581.85, "discounted_cash": 349.11, "payers_information": [{"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 320.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 426.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 102.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 439.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 378.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 282.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 436.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 317.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 436.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 465.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 354.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 465.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 268.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 315.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 315.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 436.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 378.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 426.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 432.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 337.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 436.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 315.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 317.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 465.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 432.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 436.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 337.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 436.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 416.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 635.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 494.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 480.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 426.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 426.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 436.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 439.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 416.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 635.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 480.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 439.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 378.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 494.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 436.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 426.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 432.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 432.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 436.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 317.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 378.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 346.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 311.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 432.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 268.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 317.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 300.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 287.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 416.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 635.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 494.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 494.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 320.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 480.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "EPIRUBICIN IVPB 2 MG/ML", "code_information": [{"code": "J9178", "type": "HCPCS"}], "drug_information": {"unit": 100, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 205.7, "maximum": 1270.06, "gross_charge": 1102.0, "discounted_cash": 661.2, "payers_information": [{"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 833.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1270.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 936.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 936.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 606.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 910.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 601.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 569.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 544.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 818.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 537.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 590.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 601.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 807.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 818.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 818.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 826.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 826.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 936.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 832.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 716.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 833.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1270.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 910.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 832.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 826.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 807.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 807.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 833.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1270.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 936.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 910.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 826.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 639.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 826.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 818.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 881.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 601.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 597.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 826.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 807.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 818.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 639.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 826.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 716.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 597.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 597.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 672.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 881.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 537.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 826.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 881.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 601.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 826.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 832.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 716.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 534.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 205.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 807.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 716.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 655.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 606.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "EPIRUBICIN 50 MG/25 ML INTRAVENOUS SOLUTION", "code_information": [{"code": "J9178", "type": "HCPCS"}], "drug_information": {"unit": 25, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 51.43, "maximum": 317.51, "gross_charge": 247.85, "discounted_cash": 148.71, "payers_information": [{"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 135.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 132.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 184.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 134.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 135.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 128.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 122.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 208.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 317.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 210.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 210.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 204.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 181.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 184.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 184.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 185.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 185.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 134.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 135.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 198.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 184.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 185.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 143.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 185.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 208.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 317.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 210.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 204.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 181.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 181.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 185.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 187.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 208.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 317.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 204.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 187.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 161.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 210.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 185.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 161.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 147.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 181.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 51.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 187.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 161.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 185.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 135.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 185.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 198.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 151.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 198.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 134.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 134.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 134.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 185.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 161.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 181.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 184.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 143.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ETOPOSIDE 20 MG/ML INTRAVENOUS SOLUTION", "code_information": [{"code": "J9181", "type": "HCPCS"}], "drug_information": {"unit": 25, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 131.36, "maximum": 335.24, "gross_charge": 270.85, "discounted_cash": 162.51, "payers_information": [{"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 203.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 204.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 204.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 176.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 219.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 335.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 223.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 230.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 203.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 203.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 146.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 147.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 216.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 203.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 201.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 203.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 157.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 198.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 201.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 201.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 203.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 201.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 219.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 147.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 140.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 133.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 219.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 335.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 230.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 230.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 148.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 223.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 200.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 188.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 176.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 145.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 147.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 198.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 135.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 204.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 176.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 131.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 203.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 147.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 203.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 216.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 203.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 216.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 219.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 146.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 146.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 203.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 176.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 198.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 198.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 198.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 201.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 157.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 219.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 335.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 230.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 223.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ETOPOSIDE PHOSPHATE 100 MG INTRAVENOUS SOLUTION", "code_information": [{"code": "J9181", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 43.9, "maximum": 695.13, "gross_charge": 817.8, "discounted_cash": 490.68, "payers_information": [{"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 43.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 67.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 695.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 675.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 599.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 607.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 474.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 599.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 599.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 613.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 531.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 443.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 443.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 613.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 654.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 43.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 613.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 654.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 446.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 613.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 617.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 531.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 396.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 408.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 599.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 446.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 438.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 605.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 568.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 531.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 43.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 67.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 695.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 695.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 449.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 675.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 446.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 422.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 403.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 607.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 43.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 599.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 607.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 607.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 613.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 474.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 613.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 607.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 613.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 654.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 446.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 443.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 613.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 613.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 695.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 43.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 67.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 675.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 617.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 531.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 617.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 613.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ETOPOSIDE PHOSPHATE 100 MG INTRAVENOUS SOLUTION|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "J9181", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 449.79, "maximum": 531.57, "gross_charge": 817.8, "discounted_cash": 490.68, "payers_information": [{"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 531.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 486.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 449.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 498.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FLUDARABINE 50 MG/2 ML INTRAVENOUS SOLUTION", "code_information": [{"code": "J9185", "type": "HCPCS"}], "drug_information": {"unit": 2, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 96.93, "maximum": 524.85, "gross_charge": 199.85, "discounted_cash": 119.91, "payers_information": [{"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 169.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 169.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 109.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 165.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 109.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 129.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 118.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 109.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 146.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 150.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 129.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 96.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 149.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 109.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 149.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 159.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 121.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 159.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 242.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 149.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 129.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 146.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 146.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 146.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 148.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 115.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 344.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 524.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 169.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 165.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 149.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 150.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 169.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 150.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 129.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 344.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 524.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 165.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 149.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 149.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 109.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 159.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 148.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 149.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 115.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 149.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 146.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 148.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 148.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 149.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 148.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 242.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 109.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 107.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 344.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 524.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FLUOROURACIL IV SYRINGE 50 MG/ML", "code_information": [{"code": "J9190", "type": "HCPCS"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 5.8, "maximum": 12.51, "gross_charge": 11.95, "discounted_cash": 7.17, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 12.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 12.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 12.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FLUOROURACIL 500 MG/10 ML INTRAVENOUS SOLUTION", "code_information": [{"code": "J9190", "type": "HCPCS"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 5.8, "maximum": 12.51, "gross_charge": 11.95, "discounted_cash": 7.17, "payers_information": [{"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 12.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 12.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 12.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "GEMCITABINE 1 GRAM/26.3 ML (38 MG/ML) INTRAVENOUS SOLUTION (J9201)", "code_information": [{"code": "J9201", "type": "HCPCS"}], "drug_information": {"unit": 26, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 50.0, "maximum": 123.8, "gross_charge": 145.65, "discounted_cash": 87.39, "payers_information": [{"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 109.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 75.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 115.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 123.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 109.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 109.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 109.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 75.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 115.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 123.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 109.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 109.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 109.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 116.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 109.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 116.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 50.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 109.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 75.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 115.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 123.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 123.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 107.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 101.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 109.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 109.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 109.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 116.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 109.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 50.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "GEMCITABINE 1 GRAM INTRAVENOUS SOLUTION (J9201)", "code_information": [{"code": "J9201", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 45.76, "maximum": 115.72, "gross_charge": 94.35, "discounted_cash": 56.61, "payers_information": [{"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 75.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 115.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 75.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 115.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 50.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 75.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 115.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 50.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "GEMTUZUMAB OZOGAMICIN 4.5 MG (1 MG/ML INITIAL CONCENTRATION) IV SOLN", "code_information": [{"code": "J9203", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 10807.43, "maximum": 69676.92, "gross_charge": 47824.2, "discounted_cash": 28694.52, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35055.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 35533.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 35533.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 35868.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 35533.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 35990.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26112.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24725.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23625.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25633.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 45716.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 69676.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 40650.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 40650.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 26303.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39502.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 10807.43, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 10807.43, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26112.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 31085.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 28455.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 26303.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 10807.43, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35055.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 13063.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36107.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31085.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23194.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 10807.43, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35868.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26112.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35868.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38259.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 10807.43, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29172.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38259.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 35990.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 10807.43, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25920.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25920.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 35868.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31085.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35055.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35055.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35055.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 35533.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 27738.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 45716.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 69676.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 40650.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39502.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35868.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36107.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40650.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36107.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31085.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 45716.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 69676.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39502.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 35868.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 10807.43, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 10807.43, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35868.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25920.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26112.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 10807.43, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38259.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 10807.43, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 10807.43, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 35533.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35868.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 10807.43, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 27738.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35868.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "IRINOTECAN 40 MG/2 ML INTRAVENOUS SOLUTION", "code_information": [{"code": "J9206", "type": "HCPCS"}], "drug_information": {"unit": 2, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 9.46, "maximum": 39.4, "gross_charge": 46.35, "discounted_cash": 27.81, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 9.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 15.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 23.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 9.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 15.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 23.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 15.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 23.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION", "code_information": [{"code": "J9208", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 79.43, "maximum": 259.25, "gross_charge": 305.0, "discounted_cash": 183.0, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 223.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 226.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 226.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 228.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 226.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 79.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 166.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 157.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 150.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 163.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 105.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 160.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 259.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 259.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 167.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 251.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 198.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 181.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 167.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 166.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 223.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 230.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 198.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 147.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 152.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 228.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 228.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 244.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 186.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 244.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 79.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 165.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 165.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 228.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 198.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 166.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 223.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 223.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 226.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 176.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 105.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 160.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 259.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 251.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 223.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 228.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 230.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 259.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 230.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 198.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 105.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 160.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 251.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 228.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 228.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 165.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 166.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 244.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 226.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 228.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 176.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 228.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "IFOSFAMIDE 1 GRAM/20 ML INTRAVENOUS SOLUTION", "code_information": [{"code": "J9208", "type": "HCPCS"}], "drug_information": {"unit": 20, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 79.43, "maximum": 160.14, "gross_charge": 173.9, "discounted_cash": 104.34, "payers_information": [{"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 139.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 130.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 130.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 129.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 130.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 130.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 105.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 160.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 143.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 131.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 113.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 147.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 131.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 130.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 105.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 160.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 147.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 143.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 129.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 130.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 113.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 129.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 79.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 129.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 129.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 130.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 139.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 79.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 130.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 139.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 130.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 131.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 113.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 113.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 95.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 105.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 160.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 147.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 147.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 95.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 143.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MESNA 100 MG/ML INTRAVENOUS SOLUTION", "code_information": [{"code": "J9209", "type": "HCPCS"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 22.5, "maximum": 54.8, "gross_charge": 52.2, "discounted_cash": 31.32, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 22.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 35.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 54.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 22.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 35.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 54.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 35.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 54.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "EMAPALUMAB-LZSG 5 MG/ML INTRAVENOUS SOLUTION", "code_information": [{"code": "J9210", "type": "HCPCS"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 19206.6, "maximum": 123824.31, "gross_charge": 75982.75, "discounted_cash": 45589.65, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 55695.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 56455.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 56455.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 56987.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 56455.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 64497.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "fee schedule", "standard_charge_dollar": 23610.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "fee schedule", "standard_charge_dollar": 23610.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "fee schedule", "standard_charge_dollar": 23610.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40726.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 81243.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 123824.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 64585.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 64585.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 41790.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 62761.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 19206.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 19206.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "fee schedule", "standard_charge_dollar": 23610.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 56227.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 52808.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 49388.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 19206.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 55695.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37991.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 57366.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49388.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36851.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 19206.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56987.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "fee schedule", "standard_charge_dollar": 23610.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56987.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60786.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 19206.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56987.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60786.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 64497.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 19206.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41182.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41182.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 56987.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49388.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 55695.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 55695.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 55695.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 56455.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 44070.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 81243.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 123824.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 64585.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 62761.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56987.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 57366.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 64585.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 57366.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49388.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 81243.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 123824.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 62761.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 56987.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 19206.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 19206.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56987.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41182.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "fee schedule", "standard_charge_dollar": 23610.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 19206.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60786.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 19206.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 19206.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 56455.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56987.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 19206.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 44070.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56987.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "IDARUBICIN IV SYRINGE 1 MG/ML (UNDILUTED)", "code_information": [{"code": "J9211", "type": "HCPCS"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 154.3, "maximum": 250.46, "gross_charge": 312.35, "discounted_cash": 187.41, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 228.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 250.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 154.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 167.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 171.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 171.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 228.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 156.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 249.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 249.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 250.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 169.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 234.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 228.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 228.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 228.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 181.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 234.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 169.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 249.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 181.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "IDARUBICIN 1 MG/ML INTRAVENOUS SOLUTION", "code_information": [{"code": "J9211", "type": "HCPCS"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 154.3, "maximum": 250.46, "gross_charge": 312.35, "discounted_cash": 187.41, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 228.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 181.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 228.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 228.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 234.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 169.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 249.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 250.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 249.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 156.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 228.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 171.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 171.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 167.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 154.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 250.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 228.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 181.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 249.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 169.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 234.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "INTERFERON GAMMA-1B 100 MCG (2 MILLION UNIT)/0.5 ML SUBCUTANEOUS SOLN", "code_information": [{"code": "J9216", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "minimum": 5931.08, "maximum": 34312.34, "gross_charge": 32588.35, "discounted_cash": 19553.01, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23887.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 34312.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16098.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17467.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 17923.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6713.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5931.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 17923.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23887.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16294.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26070.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26070.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 34312.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7625.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17662.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 24441.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23887.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23887.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23887.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 18901.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 24441.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7625.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7625.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17662.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7625.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26070.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 18901.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LEUPROLIDE 1 MG/0.2 ML SUBCUTANEOUS SOLUTION", "code_information": [{"code": "J9218", "type": "HCPCS"}], "drug_information": {"unit": 2, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 451.86, "maximum": 7168.98, "gross_charge": 2482.75, "discounted_cash": 1489.65, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1819.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 1844.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1844.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 1862.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1844.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7168.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1355.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1283.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1226.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2984.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 4549.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 2110.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 2110.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1365.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2050.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 511.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 451.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1330.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1355.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 1837.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1725.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 1613.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1819.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 937.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1874.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1613.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1204.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1862.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1355.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1862.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1986.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1862.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1986.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7168.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1345.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1345.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1862.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1613.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 580.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1819.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1819.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1844.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1440.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2984.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 4549.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 2110.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2050.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1819.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1862.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1874.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2110.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1874.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1613.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2984.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 4549.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2050.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1862.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 580.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 580.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1862.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1345.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1355.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 580.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1986.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1844.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1862.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1440.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1862.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LEUPROLIDE 1 MG/0.2 ML SUBCUTANEOUS KIT", "code_information": [{"code": "J9218", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 557.84, "maximum": 7168.98, "gross_charge": 3065.05, "discounted_cash": 1839.03, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2246.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 2277.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2277.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 2298.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2298.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1777.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2298.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2277.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2452.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 717.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1673.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1661.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2298.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 717.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 717.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2298.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2984.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 4549.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2531.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2314.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1992.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2605.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2314.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2298.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2246.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2984.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 4549.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 2605.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2531.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2246.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2277.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1777.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2246.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 717.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2298.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1992.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1661.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1661.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2298.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2452.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7168.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2298.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2452.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1673.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2298.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2314.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1992.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1486.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 937.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2246.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 2268.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 2130.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 1992.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1673.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1642.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 631.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 557.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2984.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 4549.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 2605.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 2605.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1685.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2531.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1673.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1584.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1514.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2277.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7168.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "IPILIMUMAB 50 MG/10 ML (5 MG/ML) INTRAVENOUS SOLUTION", "code_information": [{"code": "J9228", "type": "HCPCS"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 9345.7, "maximum": 60250.44, "gross_charge": 42472.45, "discounted_cash": 25483.47, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 24634.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31854.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 9345.7, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 31557.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31854.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 9345.7, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 9345.7, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 9345.7, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31854.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23020.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "fee schedule", "standard_charge_dollar": 11256.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 9345.7, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33977.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 9345.7, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31132.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31132.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31132.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 31557.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 24634.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 39531.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 60250.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 36101.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35082.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31854.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32066.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32066.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27607.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 39531.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 60250.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35082.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36101.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 31854.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 31557.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 30996.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "fee schedule", "standard_charge_dollar": 11256.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "fee schedule", "standard_charge_dollar": 11256.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "fee schedule", "standard_charge_dollar": 11256.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 39531.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 60250.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 36101.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 36101.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 23359.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35082.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 9345.7, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 9345.7, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22765.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "fee schedule", "standard_charge_dollar": 11256.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 27607.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 25271.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 23359.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 9345.7, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31132.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32066.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27607.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20599.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11487.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 9345.7, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31854.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "fee schedule", "standard_charge_dollar": 11256.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31854.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33977.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25908.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33977.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 30996.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 9345.7, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 9345.7, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23020.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23020.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 31854.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27607.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31132.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 31557.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 31557.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 31854.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "IPILIMUMAB 200 MG/40 ML (5 MG/ML) INTRAVENOUS SOLUTION", "code_information": [{"code": "J9228", "type": "HCPCS"}], "drug_information": {"unit": 40, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 37382.8, "maximum": 241001.75, "gross_charge": 169889.3, "discounted_cash": 101933.58, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 124528.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 126227.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 126227.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 127416.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 127416.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 110428.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 92080.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 92080.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 37382.8, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 37382.8, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 103632.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 135911.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 123986.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 127416.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 135911.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "fee schedule", "standard_charge_dollar": 45026.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 127416.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 37382.8, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 45951.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 128266.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 110428.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82396.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 124528.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 37382.8, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 110428.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 101084.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 93439.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "fee schedule", "standard_charge_dollar": 45026.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91060.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 37382.8, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 37382.8, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 158125.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 241001.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 144405.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 144405.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 93439.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 140328.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "fee schedule", "standard_charge_dollar": 45026.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "fee schedule", "standard_charge_dollar": 45026.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "fee schedule", "standard_charge_dollar": 45026.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 126227.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 123986.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 127416.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 144405.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 158125.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 241001.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 140328.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 128266.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 110428.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 128266.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 127416.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 158125.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 241001.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 144405.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 140328.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 124528.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 126227.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 98535.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 124528.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 124528.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 37382.8, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 135911.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 37382.8, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "fee schedule", "standard_charge_dollar": 45026.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 92080.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 127416.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 37382.8, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 37382.8, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 37382.8, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 127416.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 126227.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 37382.8, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 127416.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 98535.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MELPHALAN HCL 50 MG INTRAVENOUS POWDER FOR SOLUTION", "code_information": [{"code": "J9245", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 86.94, "maximum": 840.61, "gross_charge": 988.95, "discounted_cash": 593.37, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 724.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 734.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 734.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 741.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 734.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 365.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 367.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 560.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 840.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 840.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 543.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 816.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 539.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 511.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 488.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 86.94, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 86.94, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 530.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 539.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 731.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 687.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 642.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 86.94, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 724.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 363.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 746.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 642.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 479.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 86.94, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 741.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 741.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 791.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 539.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 86.94, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 741.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 791.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 365.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 536.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 536.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 741.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 642.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 86.94, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 724.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 724.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 734.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 573.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 367.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 560.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 840.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 816.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 724.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 741.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 746.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 840.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 746.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 642.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 367.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 560.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 816.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 741.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 86.94, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 86.94, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 741.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 536.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 539.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 86.94, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 791.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 86.94, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 573.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 741.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 86.94, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 86.94, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 734.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 741.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MELPHALAN (ALKERAN) 0.45 MG/ML INTRAOCULAR (PEDIATRICS)", "code_information": [{"code": "J9245", "type": "HCPCS"}], "drug_information": {"unit": 111, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 86.94, "maximum": 2684.39, "gross_charge": 3158.1, "discounted_cash": 1894.86, "payers_information": [{"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2368.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2346.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 86.94, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 86.94, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2368.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1831.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 86.94, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2526.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 86.94, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1724.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1711.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2368.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 86.94, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 86.94, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2368.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 367.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 560.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2608.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2384.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2052.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2684.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2384.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2368.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2314.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 367.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 560.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 2684.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2608.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2314.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2346.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1831.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2314.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 86.94, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2368.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2052.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1711.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1711.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2368.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2526.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 365.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 86.94, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1724.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2368.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2526.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2368.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 86.94, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2384.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2052.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1531.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 363.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2314.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 86.94, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2346.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 365.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 367.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 560.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 2684.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 2684.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1736.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2608.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 2336.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 2194.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1724.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1692.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 86.94, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 86.94, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1724.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1632.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1560.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 2052.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2314.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 2346.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2346.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 2368.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "METHOTREXATE SODIUM (PF) 25 MG/ML INJECTION SOLUTION", "code_information": [{"code": "J9260", "type": "HCPCS"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 7.64, "maximum": 332.67, "gross_charge": 28.6, "discounted_cash": 17.16, "payers_information": [{"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 38.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 54.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 83.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 54.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 83.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 54.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 83.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 38.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "METHOTREXATE SODIUM (PF) 25 MG/ML INJECTION SOLUTION", "code_information": [{"code": "J9260", "type": "HCPCS"}], "drug_information": {"unit": 2, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 7.64, "maximum": 332.67, "gross_charge": 63.95, "discounted_cash": 38.37, "payers_information": [{"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 10.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 16.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 10.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 16.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 10.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 16.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "METHOTREXATE SODIUM (PF) 25 MG/ML INJECTION SOLUTION", "code_information": [{"code": "J9260", "type": "HCPCS"}], "drug_information": {"unit": 40, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 7.64, "maximum": 332.67, "gross_charge": 69.0, "discounted_cash": 41.4, "payers_information": [{"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 152.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 218.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 332.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 218.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 332.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 218.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 332.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 152.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "METHOTREXATE SODIUM 25 MG/ML INJECTION SOLUTION", "code_information": [{"code": "J9260", "type": "HCPCS"}], "drug_information": {"unit": 2, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 7.64, "maximum": 26.48, "gross_charge": 31.15, "discounted_cash": 18.69, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 10.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 16.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 10.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 16.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 10.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 16.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "METHOTREXATE SODIUM (PF) 1 GRAM SOLUTION FOR INJECTION", "code_information": [{"code": "J9260", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 113.54, "maximum": 332.67, "gross_charge": 234.1, "discounted_cash": 140.46, "payers_information": [{"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 125.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 173.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 162.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 152.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 218.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 332.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 198.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 198.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 128.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 193.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 171.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 173.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 173.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 175.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 173.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 152.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 121.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 115.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 171.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 117.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 176.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 152.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 113.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 175.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 175.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 187.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 175.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 187.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 152.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 126.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 126.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 175.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 152.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 171.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 171.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 171.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 173.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 135.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 218.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 332.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 198.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 193.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 175.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 176.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 176.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 152.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 218.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 332.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 193.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 198.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 175.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 175.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 175.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 126.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 187.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 173.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 175.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 135.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "METHOTREXATE IV SYRINGE 25 MG/ML", "code_information": [{"code": "J9260", "type": "HCPCS"}], "drug_information": {"unit": 2, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 7.64, "maximum": 22.1, "gross_charge": 26.0, "discounted_cash": 15.6, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 10.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 16.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 10.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 16.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 10.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 16.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "METHOTREXATE INTRAMUSCULAR SYRINGE 25 MG/ML", "code_information": [{"code": "J9260", "type": "HCPCS"}], "drug_information": {"unit": 2, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 7.64, "maximum": 22.1, "gross_charge": 26.0, "discounted_cash": 15.6, "payers_information": [{"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 10.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 16.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 10.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 16.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 10.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 16.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "METHOTREXATE SUBCUTANEOUS SYRINGE 25 MG/ML", "code_information": [{"code": "J9260", "type": "HCPCS"}], "drug_information": {"unit": 2, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 7.64, "maximum": 22.1, "gross_charge": 26.0, "discounted_cash": 15.6, "payers_information": [{"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 10.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 16.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 10.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 16.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 10.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 16.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "METHOTREXATE IV SYRINGE 25 MG/ML (PEDIATRICS)", "code_information": [{"code": "J9260", "type": "HCPCS"}], "drug_information": {"unit": 2, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 7.64, "maximum": 22.1, "gross_charge": 26.0, "discounted_cash": 15.6, "payers_information": [{"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 10.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 16.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 10.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 16.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 10.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 16.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "NELARABINE 5 MG/ML INTRAVENOUS SOLUTION", "code_information": [{"code": "J9261", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 325.8, "maximum": 2100.43, "gross_charge": 681.75, "discounted_cash": 409.05, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 499.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 506.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 506.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 511.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 506.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1071.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 372.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 352.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 336.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 365.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1378.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 2100.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 579.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 579.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 374.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 563.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 325.8, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 325.8, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 372.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 504.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 473.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 443.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 325.8, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 499.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 872.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 514.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 443.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 330.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 325.8, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 511.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 372.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 511.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 545.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 325.8, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 511.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 545.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1071.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 325.8, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 369.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 369.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 511.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 443.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 499.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 499.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 499.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 506.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 395.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1378.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 2100.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 579.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 563.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 511.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 514.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 579.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 514.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 443.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1378.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 2100.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 563.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 511.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 325.8, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 325.8, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 511.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 369.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 372.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 325.8, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 545.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 325.8, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 325.8, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 506.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 511.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 325.8, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 395.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 511.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OXALIPLATIN 50 MG INTRAVENOUS SOLUTION", "code_information": [{"code": "J9263", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 21.15, "maximum": 557.81, "gross_charge": 656.25, "discounted_cash": 393.75, "payers_information": [{"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 492.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 355.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 358.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 525.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 487.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 495.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 557.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 495.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 426.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 21.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 32.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 542.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 492.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 492.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 492.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 380.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 492.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 481.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 487.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 487.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 492.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 481.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 487.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 30.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 358.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 339.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 21.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 32.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 557.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 557.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 360.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 542.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 351.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 426.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 390.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 360.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 358.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 481.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 495.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 426.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 318.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 328.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 492.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 492.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 525.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 400.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 525.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 30.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 355.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 355.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 492.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 426.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 358.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 481.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 481.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 487.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 380.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 21.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 32.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 557.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 542.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OXALIPLATIN 100 MG/20 ML INTRAVENOUS SOLUTION", "code_information": [{"code": "J9263", "type": "HCPCS"}], "drug_information": {"unit": 20, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 27.18, "maximum": 64.47, "gross_charge": 56.05, "discounted_cash": 33.63, "payers_information": [{"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 64.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 42.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 64.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 42.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 64.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 60.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 42.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 60.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PACLITAXEL 6 MG/ML CONCENTRATE,INTRAVENOUS", "code_information": [{"code": "J9267", "type": "HCPCS"}], "drug_information": {"unit": 16, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 37.74, "maximum": 127.16, "gross_charge": 149.6, "discounted_cash": 89.76, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 109.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 111.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 111.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 111.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 37.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 43.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 65.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 123.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 97.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 109.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 97.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 119.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 119.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 37.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 97.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 109.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 109.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 109.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 111.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 43.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 65.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 123.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 97.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 43.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 65.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 123.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 119.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 111.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PENTOSTATIN 10 MG INTRAVENOUS SOLUTION", "code_information": [{"code": "J9268", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 2537.1, "maximum": 16356.68, "gross_charge": 11043.2, "discounted_cash": 6625.92, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8094.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 8205.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 8205.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 8282.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 8205.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8598.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6029.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5709.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5455.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5919.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 10731.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 16356.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 9386.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 9386.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 6073.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9121.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2537.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2537.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6029.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 7178.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 6570.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 6073.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2537.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8094.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3895.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8337.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7178.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5355.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2537.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8282.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6029.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8282.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8834.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2537.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6736.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8834.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8598.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2537.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5985.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5985.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 8282.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7178.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8094.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8094.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8094.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 8205.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6405.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 10731.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 16356.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 9386.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9121.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8282.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8337.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9386.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8337.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7178.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 10731.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 16356.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9121.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 8282.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2537.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2537.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8282.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5985.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6029.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2537.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8834.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2537.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2537.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 8205.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8282.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2537.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6405.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8282.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PEMBROLIZUMAB 25 MG/ML INTRAVENOUS SOLUTION", "code_information": [{"code": "J9271", "type": "HCPCS"}], "drug_information": {"unit": 4, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 5972.6, "maximum": 38507.93, "gross_charge": 27664.0, "discounted_cash": 16598.4, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20277.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 20554.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 20554.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 20748.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 20554.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 19793.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15104.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14302.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13666.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14827.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 25265.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 38507.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 23514.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 23514.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 15215.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22850.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5972.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5972.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15104.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 17981.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 16460.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 15215.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5972.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20277.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 7631.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20886.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17981.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13417.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5972.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20748.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15104.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20748.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22131.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5972.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16875.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22131.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 19793.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5972.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14993.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14993.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 20748.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17981.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20277.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20277.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20277.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 20554.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 16045.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 25265.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 38507.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 23514.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22850.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20748.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20886.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23514.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20886.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17981.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 25265.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 38507.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22850.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 20748.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5972.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5972.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20748.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14993.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15104.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5972.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22131.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5972.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5972.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 20554.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20748.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 5972.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 16045.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20748.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MITOMYCIN 20 MG INTRAVENOUS SOLUTION", "code_information": [{"code": "J9280", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 104.42, "maximum": 2315.66, "gross_charge": 2724.3, "discounted_cash": 1634.58, "payers_information": [{"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2043.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1770.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1996.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2024.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1580.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 441.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 673.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 2315.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2250.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1996.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1996.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2043.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2056.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 441.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 673.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2250.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2056.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1770.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2315.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2043.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 104.42, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 104.42, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2043.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1476.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1487.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 104.42, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2179.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 104.42, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2043.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 104.42, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2024.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2043.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 104.42, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1580.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1996.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 2024.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2024.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 2043.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2024.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 382.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1487.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1408.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1345.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 441.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 673.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 2315.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 2315.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1498.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2250.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1460.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 104.42, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 104.42, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 1770.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1620.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 1498.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1487.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 104.42, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1996.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1362.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2056.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1770.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1321.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 104.42, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2043.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2043.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2179.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1661.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2179.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 382.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1487.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 104.42, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1476.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1476.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 104.42, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MITOMYCIN 5 MG INTRAVENOUS SOLUTION", "code_information": [{"code": "J9280", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 26.1, "maximum": 220.36, "gross_charge": 259.25, "discounted_cash": 155.55, "payers_information": [{"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 26.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 140.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 140.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 26.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 141.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 158.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 207.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 95.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 194.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 207.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 194.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 26.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 195.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 168.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 125.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 129.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 190.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 26.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 141.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 168.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 154.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 142.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 26.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 26.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 138.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 110.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 168.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 220.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 220.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 142.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 214.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 141.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 134.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 128.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 192.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 95.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 190.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 192.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 192.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 194.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 150.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 26.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 194.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 192.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 26.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 194.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 26.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 207.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 26.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 141.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 140.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 194.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 26.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 26.1, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 194.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 220.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 195.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 168.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 110.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 168.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 214.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 195.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 194.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 190.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 190.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 110.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 168.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 220.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 214.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 190.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 192.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 150.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 194.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 168.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MITOMYCIN IV SYRINGE 0.5 MG/ML", "code_information": [{"code": "J9280", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 104.42, "maximum": 2315.66, "gross_charge": 2724.3, "discounted_cash": 1634.58, "payers_information": [{"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1476.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2043.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1770.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1996.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2024.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1580.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 441.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 673.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 2315.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2250.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1996.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1996.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2043.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2056.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 441.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 673.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2250.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2056.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1770.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2315.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2043.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 104.42, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 104.42, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2043.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1476.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1487.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 104.42, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2179.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 104.42, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1580.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 104.42, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2024.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2043.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 104.42, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2043.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2024.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 382.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1487.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1408.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1345.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 441.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 673.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 2315.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 2315.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1498.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2250.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1996.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 2024.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2024.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 2043.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1460.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 104.42, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 104.42, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 1770.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1620.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 1498.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1487.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 104.42, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1996.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1362.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2056.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1770.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1321.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 104.42, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1487.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 104.42, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1476.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 104.42, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2043.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2043.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2179.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1661.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2179.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 382.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MITOXANTRONE 2 MG/ML CONCENTRATE,INTRAVENOUS", "code_information": [{"code": "J9293", "type": "HCPCS"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 123.51, "maximum": 409.08, "gross_charge": 511.35, "discounted_cash": 306.81, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 374.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 400.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 252.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 274.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 281.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 123.51, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 123.51, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 281.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 123.51, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 374.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 255.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 123.51, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 409.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 123.51, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 409.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 400.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 123.51, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 277.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 383.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 374.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 374.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 374.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 296.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 383.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 123.51, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 123.51, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 277.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 123.51, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 409.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 123.51, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 123.51, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 123.51, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 296.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "NIVOLUMAB 40 MG/4 ML INTRAVENOUS SOLUTION", "code_information": [{"code": "J9299", "type": "HCPCS"}], "drug_information": {"unit": 4, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 1342.92, "maximum": 8657.03, "gross_charge": 6209.75, "discounted_cash": 3725.85, "payers_information": [{"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4551.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4551.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5680.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 8657.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5278.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5129.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4551.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4613.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3601.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4657.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4688.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4688.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4036.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5680.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 8657.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5129.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5278.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 4657.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1342.92, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1342.92, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4657.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3365.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "fee schedule", "standard_charge_dollar": 1617.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1342.92, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4967.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1342.92, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1342.92, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4613.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4657.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1342.92, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3601.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4657.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "fee schedule", "standard_charge_dollar": 1617.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1342.92, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4657.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4967.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4461.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3365.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3365.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1342.92, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 4657.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4036.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3328.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1342.92, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1342.92, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 4595.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4315.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 4036.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "fee schedule", "standard_charge_dollar": 1617.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1342.92, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4551.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1679.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4688.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4036.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3011.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1342.92, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4657.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4657.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4967.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4551.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 4613.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4613.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 4657.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4613.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4461.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "fee schedule", "standard_charge_dollar": 1617.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "fee schedule", "standard_charge_dollar": 1617.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1617.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5680.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 8657.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 5278.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 5278.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3415.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5129.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "NIVOLUMAB 100 MG/10 ML INTRAVENOUS SOLUTION", "code_information": [{"code": "J9299", "type": "HCPCS"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 3357.3, "maximum": 21642.58, "gross_charge": 15524.1, "discounted_cash": 9314.46, "payers_information": [{"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 14200.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 21642.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 13195.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 13195.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 8538.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12822.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "fee schedule", "standard_charge_dollar": 4044.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "fee schedule", "standard_charge_dollar": 4044.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "fee schedule", "standard_charge_dollar": 4044.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 11534.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11154.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11379.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 11534.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 11534.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 11643.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11643.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12419.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11643.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3357.3, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11720.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10090.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7529.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4198.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11379.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3357.3, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "fee schedule", "standard_charge_dollar": 4044.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 11487.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 10789.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 10090.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3357.3, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3357.3, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8320.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3357.3, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8414.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8414.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11643.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12419.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11154.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3357.3, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "fee schedule", "standard_charge_dollar": 4044.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11643.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 9003.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3357.3, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11643.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 11534.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3357.3, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3357.3, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12419.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3357.3, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "fee schedule", "standard_charge_dollar": 4044.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8414.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11643.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3357.3, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3357.3, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 11643.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13195.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 14200.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 21642.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12822.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11720.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10090.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11720.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11643.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11379.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 11534.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 9003.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 14200.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 21642.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 13195.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12822.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11379.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11379.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 11643.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10090.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OFATUMUMAB 100 MG/5 ML INTRAVENOUS SOLUTION", "code_information": [{"code": "J9302", "type": "HCPCS"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 622.34, "maximum": 2212.6, "gross_charge": 2765.75, "discounted_cash": 1659.45, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2027.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2103.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1366.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1482.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1521.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 622.34, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 622.34, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1521.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 622.34, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2027.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 796.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 622.34, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2212.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 622.34, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2212.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2103.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 622.34, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1499.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2074.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2027.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2027.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2027.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1604.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2074.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 622.34, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 622.34, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1499.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 622.34, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2212.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 622.34, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 622.34, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 622.34, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1604.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "RITUXIMAB 10 MG/ML CONCENTRATE,INTRAVENOUS", "code_information": [{"code": "J9312", "type": "HCPCS"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 747.65, "maximum": 24102.11, "gross_charge": 3897.8, "discounted_cash": 2338.68, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2857.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 2896.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2896.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 2923.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2896.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2566.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2128.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2015.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1925.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2089.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3162.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 4820.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 3313.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 3313.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2143.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3219.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 747.65, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 747.65, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2128.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 2884.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 2708.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 2533.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 747.65, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2857.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1240.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2942.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2533.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1890.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 747.65, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2923.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2128.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2923.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3118.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 747.65, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2923.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3118.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2566.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 747.65, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2112.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2112.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2923.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2533.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2857.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2857.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2857.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2896.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2260.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3162.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 4820.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 3313.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3219.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2923.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2942.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3313.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2942.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2533.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3162.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 4820.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3219.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2923.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 747.65, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 747.65, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2923.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2112.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2128.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 747.65, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3118.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 747.65, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 747.65, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2896.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2923.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 747.65, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2260.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2923.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "RITUXIMAB 10 MG/ML CONCENTRATE,INTRAVENOUS", "code_information": [{"code": "J9312", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 747.65, "maximum": 24102.11, "gross_charge": 19488.8, "discounted_cash": 11693.28, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14285.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 14480.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 14480.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 14616.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 14480.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 12832.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10640.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10075.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9627.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10446.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 15813.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 24102.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 16565.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 16565.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10718.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16097.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3738.25, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3738.25, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10640.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 14421.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 13544.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 12667.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3738.25, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14285.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6200.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14714.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12667.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9452.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3738.25, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14616.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10640.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14616.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15591.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3738.25, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14616.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15591.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 12832.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3738.25, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10562.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10562.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 14616.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12667.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14285.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14285.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14285.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 14480.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 11303.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 15813.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 24102.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 16565.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16097.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14616.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14714.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16565.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14714.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12667.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 15813.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 24102.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16097.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 14616.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3738.25, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3738.25, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14616.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10562.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10640.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3738.25, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15591.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3738.25, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3738.25, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 14480.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14616.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3738.25, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 11303.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14616.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TEMOZOLOMIDE 100 MG INTRAVENOUS SOLUTION", "code_information": [{"code": "J9328", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 1039.8, "maximum": 3512.0, "gross_charge": 4356.95, "discounted_cash": 2614.17, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3512.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1039.8, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1039.8, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1039.8, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1324.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1039.8, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1039.8, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3485.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3512.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1039.8, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2527.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1039.8, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1039.8, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1039.8, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1039.8, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1039.8, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1039.8, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2527.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TEMSIROLIMUS 30 MG/3 ML (10 MG/ML) (FIRST DILUTION) INTRAVENOUS SOLN", "code_information": [{"code": "J9330", "type": "HCPCS"}], "drug_information": {"unit": 3, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 609.48, "maximum": 3930.09, "gross_charge": 3179.55, "discounted_cash": 1907.73, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2330.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 2362.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2362.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 2384.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2362.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3274.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1736.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1643.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1570.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1704.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2578.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 3930.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 2702.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 2702.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1748.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2626.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 609.48, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 609.48, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1736.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 2066.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1891.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 1748.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 609.48, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2330.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2043.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2400.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2066.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1542.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 609.48, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2384.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1736.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2384.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2543.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 609.48, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1939.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2543.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 3274.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 609.48, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1723.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1723.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2384.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2066.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2330.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2330.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2330.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2362.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1844.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2578.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 3930.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 2702.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2626.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2384.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2400.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2702.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2400.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2066.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2578.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 3930.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2626.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2384.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 609.48, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 609.48, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2384.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1723.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1736.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 609.48, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2543.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 609.48, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 609.48, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2362.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2384.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 609.48, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1844.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2384.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "THIOTEPA 100 MG SOLUTION FOR INJECTION", "code_information": [{"code": "J9342", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 886.3, "maximum": 4137.0, "gross_charge": 3366.15, "discounted_cash": 2019.69, "payers_information": [{"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2692.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 886.3, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 886.3, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 886.3, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2467.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1952.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2467.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2524.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 886.3, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 886.3, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1824.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 886.3, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1952.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2467.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4137.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1662.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1804.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 886.3, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 886.3, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1851.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1851.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 886.3, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2467.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1683.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 886.3, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2692.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 886.3, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2692.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4137.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 886.3, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1824.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2524.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2467.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "THIOTEPA 15 MG SOLUTION FOR INJECTION", "code_information": [{"code": "J9342", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 132.95, "maximum": 620.55, "gross_charge": 648.15, "discounted_cash": 388.89, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 375.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 132.95, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 351.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 132.95, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 132.95, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 486.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 475.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 475.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 375.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 132.95, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 132.95, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 132.95, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 518.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 475.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 486.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 351.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 132.95, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 518.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 620.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 132.95, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 518.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 132.95, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 324.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 475.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 132.95, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 356.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 356.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 132.95, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 132.95, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 347.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 320.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 620.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 475.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "NAXITAMAB-GQGK 4 MG/ML INTRAVENOUS SOLUTION", "code_information": [{"code": "J9348", "type": "HCPCS"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 27443.32, "maximum": 99050.44, "gross_charge": 123813.05, "discounted_cash": 74287.83, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 90754.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 92735.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 61163.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 66363.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 68097.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 27443.32, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 27443.32, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 68097.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 27443.32, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 90754.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 61906.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 27443.32, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 99050.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 27443.32, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 99050.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 92735.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 27443.32, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 67106.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 92859.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 90754.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 90754.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 90754.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 71811.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 92859.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 27443.32, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 27443.32, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 67106.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 27443.32, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 99050.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 27443.32, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 27443.32, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 27443.32, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 71811.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TOPOTECAN 4 MG/4 ML (1 MG/ML) INTRAVENOUS SOLUTION", "code_information": [{"code": "J9351", "type": "HCPCS"}], "drug_information": {"unit": 4, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 122.32, "maximum": 322.35, "gross_charge": 252.2, "discounted_cash": 151.32, "payers_information": [{"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 163.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 184.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 184.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 187.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 146.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 211.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 322.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 214.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 208.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 189.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 184.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 189.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 190.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 214.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 190.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 163.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 211.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 322.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 208.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 189.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 189.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 137.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 201.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 187.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 189.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 146.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 184.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 187.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 187.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 189.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 187.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 181.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 137.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 130.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 124.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 211.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 322.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 214.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 214.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 138.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 208.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 135.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 163.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 150.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 138.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 137.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 184.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 190.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 163.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 122.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 126.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 189.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 189.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 201.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 153.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 201.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 181.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 189.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 137.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TOPOTECAN 4 MG INTRAVENOUS SOLUTION", "code_information": [{"code": "J9351", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 181.2, "maximum": 571.2, "gross_charge": 672.0, "discounted_cash": 403.2, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 389.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 504.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 499.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 537.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 366.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 364.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 504.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 504.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 211.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 322.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 555.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 507.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 436.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 571.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 507.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 504.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 492.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 504.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 211.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 322.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 571.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 555.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 492.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 499.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 389.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 492.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 504.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 436.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 366.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 364.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 364.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 409.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 537.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 181.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 504.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 537.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 504.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 336.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 507.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 436.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 325.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 492.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 366.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 436.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 399.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 369.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 360.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 211.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 322.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 571.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 571.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 369.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 555.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 366.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 347.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 331.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 499.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 181.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 492.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 499.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 499.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 504.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "VINBLASTINE 1 MG/ML INTRAVENOUS SOLUTION", "code_information": [{"code": "J9360", "type": "HCPCS"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 135.75, "maximum": 333.95, "gross_charge": 279.9, "discounted_cash": 167.94, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 205.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 207.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 207.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 209.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 207.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 178.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 152.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 144.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 138.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 150.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 219.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 333.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 237.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 237.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 153.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 231.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 152.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 207.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 194.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 181.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 205.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 139.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 211.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 181.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 135.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 209.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 152.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 209.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 223.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 209.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 223.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 178.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 151.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 151.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 209.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 181.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 205.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 205.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 205.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 207.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 162.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 219.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 333.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 237.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 231.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 209.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 211.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 237.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 211.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 181.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 219.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 333.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 231.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 209.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 209.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 151.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 152.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 223.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 207.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 209.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 162.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 209.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "VINCRISTINE 2 MG/2 ML INTRAVENOUS SOLUTION", "code_information": [{"code": "J9370", "type": "HCPCS"}], "drug_information": {"unit": 2, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 31.94, "maximum": 105.09, "gross_charge": 65.85, "discounted_cash": 39.51, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 53.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 68.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 105.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 53.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 68.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 105.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 68.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 105.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "VINCRISTINE 1 MG/ML INTRAVENOUS SOLUTION", "code_information": [{"code": "J9370", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 26.57, "maximum": 73.06, "gross_charge": 85.95, "discounted_cash": 51.57, "payers_information": [{"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 34.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 52.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 26.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 34.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 52.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 34.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 52.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 26.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TEPLIZUMAB-MZWV 2,000 MCG/20 ML (FIRST DILUTION) INTRAVENOUS SOLUTION", "code_information": [{"code": "J9381", "type": "HCPCS"}], "drug_information": {"unit": 20, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 15354.4, "maximum": 99000.13, "gross_charge": 62325.0, "discounted_cash": 37395.0, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45684.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 46307.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 46307.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 46743.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 46307.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 50904.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "fee schedule", "standard_charge_dollar": 18484.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "fee schedule", "standard_charge_dollar": 18484.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "fee schedule", "standard_charge_dollar": 18484.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33406.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 64955.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 99000.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 52976.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 52976.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 34278.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51480.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 15354.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 15354.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "fee schedule", "standard_charge_dollar": 18484.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 46120.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 43315.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 40511.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 15354.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45684.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31162.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47055.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40511.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30227.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 15354.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46743.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "fee schedule", "standard_charge_dollar": 18484.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46743.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49860.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 15354.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46743.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49860.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 50904.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 15354.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33780.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33780.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 46743.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40511.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45684.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45684.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45684.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 46307.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 36148.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 64955.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 99000.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 52976.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51480.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46743.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47055.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52976.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47055.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40511.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 64955.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 99000.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51480.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 46743.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 15354.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 15354.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46743.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33780.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "fee schedule", "standard_charge_dollar": 18484.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 15354.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49860.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 15354.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 15354.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 46307.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46743.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 15354.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 36148.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46743.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "VINORELBINE 10 MG/ML INTRAVENOUS SOLUTION", "code_information": [{"code": "J9390", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 6.62, "maximum": 42.03, "gross_charge": 49.45, "discounted_cash": 29.67, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 23.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 35.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 23.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 35.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 23.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 35.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "VINORELBINE 50 MG/5 ML INTRAVENOUS SOLUTION", "code_information": [{"code": "J9390", "type": "HCPCS"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 33.1, "maximum": 175.36, "gross_charge": 152.5, "discounted_cash": 91.5, "payers_information": [{"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 115.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 175.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 125.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 122.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 113.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 88.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 115.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 115.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 115.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 175.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 129.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 125.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 111.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 113.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 88.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 111.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 111.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 122.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 33.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 122.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 115.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 111.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 111.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 113.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 113.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 115.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 175.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 129.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 129.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 125.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 113.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 33.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 129.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ALBUMIN, HUMAN 5 % INTRAVENOUS SOLUTION", "code_information": [{"code": "P9041", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 10.62, "maximum": 342.21, "gross_charge": 132.6, "discounted_cash": 79.56, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 97.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 35.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 44.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 68.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 109.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 10.62, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 10.62, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 10.62, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 97.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 10.62, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 10.62, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 35.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 10.62, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 97.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 97.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 97.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 44.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 68.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 109.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 44.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 68.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 109.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 10.62, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 10.62, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 72.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 10.62, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 10.62, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 10.62, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 10.62, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ALBUMIN, HUMAN 5 % INTRAVENOUS SOLUTION", "code_information": [{"code": "P9045", "type": "HCPCS"}], "drug_information": {"unit": 250, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 10.62, "maximum": 342.21, "gross_charge": 182.45, "discounted_cash": 109.47, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 133.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 135.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 135.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 135.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 179.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 97.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 224.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 342.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 155.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 155.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 150.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 53.08, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 53.08, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 135.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 126.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 118.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 53.08, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 133.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 137.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 118.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 88.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 53.08, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 145.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 53.08, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 145.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 179.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 53.08, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 118.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 133.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 133.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 133.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 135.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 224.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 342.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 155.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 150.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 137.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 155.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 137.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 118.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 224.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 342.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 150.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 53.08, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 53.08, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 53.08, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 145.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 53.08, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 53.08, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 135.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 53.08, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION (DOSE IN MG FOR ERX 501081)", "code_information": [{"code": "P9047", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 53.08, "maximum": 342.21, "gross_charge": 208.15, "discounted_cash": 124.89, "payers_information": [{"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 156.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 53.08, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 166.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 53.08, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 53.08, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 154.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 156.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 53.08, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 111.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 53.08, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 53.08, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 113.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 107.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 154.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 144.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 135.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 113.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 53.08, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 152.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 157.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 135.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 100.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 53.08, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 156.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 156.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 166.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 156.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 166.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 179.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 113.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 53.08, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 156.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 135.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 53.08, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 152.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 152.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 154.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 224.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 342.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 176.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 171.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 152.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 156.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 157.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 176.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 224.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 342.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 171.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 157.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 135.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 156.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 53.08, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 53.08, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 156.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 113.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 154.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 179.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 152.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 154.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 154.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 156.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 224.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 342.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 176.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 176.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 171.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION (DOSE IN MG FOR ERX 501081)|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "P9047", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 114.48, "maximum": 135.3, "gross_charge": 208.15, "discounted_cash": 124.89, "payers_information": [{"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 135.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION (FOR ANESTHESIA OSM)", "code_information": [{"code": "P9047", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 53.08, "maximum": 342.21, "gross_charge": 190.35, "discounted_cash": 114.21, "payers_information": [{"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 142.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 110.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 53.08, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 142.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 141.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 53.08, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 53.08, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 152.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 53.08, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 140.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 132.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 123.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 53.08, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 53.08, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 142.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 152.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 179.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 142.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 152.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 142.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 53.08, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 143.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 123.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 95.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 139.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 53.08, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 142.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 53.08, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 53.08, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 142.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 143.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 123.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 224.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 342.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 157.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 161.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 143.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 142.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 139.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 224.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 342.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 161.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 157.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 139.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 141.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 110.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 139.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 53.08, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 142.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 123.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 53.08, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 224.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 342.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 161.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 161.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 157.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 139.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 141.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 141.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 142.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 141.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 179.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION (FOR ANESTHESIA OSM)|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "P9047", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 104.69, "maximum": 123.73, "gross_charge": 190.35, "discounted_cash": 114.21, "payers_information": [{"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 123.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION", "code_information": [{"code": "P9047", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 53.08, "maximum": 342.21, "gross_charge": 190.35, "discounted_cash": 114.21, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 141.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 179.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 139.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 141.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 141.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 142.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 224.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 342.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 161.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 161.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 157.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 142.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 53.08, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 152.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 53.08, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 53.08, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 141.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 142.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 53.08, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 110.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 140.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 132.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 123.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 53.08, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 53.08, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 53.08, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 139.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 95.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 143.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 123.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 53.08, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 142.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 142.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 152.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 142.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 152.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 179.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 53.08, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 142.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 123.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 53.08, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 139.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 139.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 141.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 110.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 224.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 342.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 161.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 157.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 139.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 142.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 143.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 161.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 224.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 342.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 157.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 143.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 123.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 142.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 53.08, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 53.08, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 142.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "P9047", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 104.69, "maximum": 123.73, "gross_charge": 190.35, "discounted_cash": 114.21, "payers_information": [{"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 123.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 8, "type": "GR"}, "standard_charges": [{"setting": "outpatient", "minimum": 5.62, "maximum": 24.72, "gross_charge": 30.9, "payers_information": [{"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FLUTICASONE PROPIONATE 44 MCG/ACTUATION HFA AEROSOL INHALER", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 10, "type": "GR"}, "standard_charges": [{"setting": "outpatient", "minimum": 33.19, "maximum": 145.88, "gross_charge": 182.35, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 145.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 130.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 130.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 12, "type": "GR"}, "standard_charges": [{"setting": "outpatient", "minimum": 44.44, "maximum": 195.32, "gross_charge": 244.15, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 141.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 141.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 174.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 195.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 174.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "IPRATROPIUM BROMIDE 17 MCG/ACTUATION HFA AEROSOL INHALER", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 12, "type": "GR"}, "standard_charges": [{"setting": "outpatient", "minimum": 76.6, "maximum": 336.72, "gross_charge": 420.9, "payers_information": [{"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 244.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 244.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 336.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 300.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 300.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LEVALBUTEROL HFA 45 MCG/ACTUATION AEROSOL INHALER", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 15, "type": "GR"}, "standard_charges": [{"setting": "outpatient", "minimum": 14.72, "maximum": 64.72, "gross_charge": 80.9, "payers_information": [{"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FLUTICASONE PROPIONATE 45 MCG-SALMETEROL 21 MCG/ACTUATION HFA INHALER", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 8, "type": "GR"}, "standard_charges": [{"setting": "outpatient", "minimum": 41.65, "maximum": 183.08, "gross_charge": 228.85, "payers_information": [{"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 132.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 132.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 183.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 163.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 163.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FLUTICASONE PROPIONATE 115 MCG-SALMETEROL 21 MCG/ACTUATION HFA INHALER", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 8, "type": "GR"}, "standard_charges": [{"setting": "outpatient", "minimum": 38.68, "maximum": 170.0, "gross_charge": 212.5, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 151.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 170.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 151.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 123.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 123.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FLUTICASONE PROPIONATE 230 MCG-SALMETEROL 21 MCG/ACTUATION HFA INHALER", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 8, "type": "GR"}, "standard_charges": [{"setting": "outpatient", "minimum": 63.21, "maximum": 277.84, "gross_charge": 347.3, "payers_information": [{"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 201.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 201.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 277.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 247.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 247.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "BUDESONIDE-FORMOTEROL HFA 80 MCG-4.5 MCG/ACTUATION AEROSOL INHALER", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 6, "type": "GR"}, "standard_charges": [{"setting": "outpatient", "minimum": 15.23, "maximum": 66.96, "gross_charge": 83.7, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "BUDESONIDE-FORMOTEROL HFA 160 MCG-4.5 MCG/ACTUATION AEROSOL INHALER", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 6, "type": "GR"}, "standard_charges": [{"setting": "outpatient", "minimum": 15.23, "maximum": 66.96, "gross_charge": 83.7, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FERUMOXYTOL 510 MG/17 ML (30 MG/ML) INTRAVENOUS SOLUTION", "code_information": [{"code": "Q0138", "type": "HCPCS"}], "drug_information": {"unit": 17, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 183.6, "maximum": 1183.67, "gross_charge": 673.05, "discounted_cash": 403.83, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 493.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 500.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 500.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 504.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 500.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 535.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 367.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 347.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 332.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 360.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 776.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1183.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 572.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 572.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 370.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 555.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 183.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 183.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 367.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 498.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 467.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 437.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 183.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 493.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 336.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 508.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 437.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 326.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 183.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 504.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 367.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 504.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 538.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 183.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 504.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 538.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 535.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 183.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 364.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 364.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 504.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 437.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 493.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 493.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 493.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 500.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 390.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 776.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1183.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 572.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 555.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 504.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 508.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 572.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 508.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 437.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 776.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1183.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 555.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 504.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 183.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 183.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 504.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 364.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 367.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 183.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 538.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 183.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 183.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 500.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 504.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 183.6, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 390.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 504.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ONDANSETRON 4 MG DISINTEGRATING TABLET", "code_information": [{"code": "Q0162", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.69, "maximum": 1.12, "gross_charge": 1.4, "discounted_cash": 0.84, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PROMETHAZINE 6.25 MG/5 ML ORAL SYRUP", "code_information": [{"code": "Q0169", "type": "HCPCS"}], "drug_information": {"unit": 473, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 27.87, "maximum": 38.44, "gross_charge": 48.05, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PEMIVIBART 125 MG/ML INTRAVENOUS SOLUTION (EUA)", "code_information": [{"code": "Q0224", "type": "HCPCS"}], "drug_information": {"unit": 36, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 9429.77, "maximum": 46669.83, "gross_charge": 28575.05, "discounted_cash": 17145.03, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20945.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 21231.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 21231.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 21431.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 21231.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 24467.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15601.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14773.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14116.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15316.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 30620.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 46669.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 24288.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 24288.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 15716.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23602.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10572.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10572.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15601.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 18573.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 17002.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 15716.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10572.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20945.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14287.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21574.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18573.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13858.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9429.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21431.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15601.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21431.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22860.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10572.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17430.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22860.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 24467.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10572.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15487.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15487.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 21431.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18573.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20945.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20945.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20945.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 21231.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 16573.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 30620.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 46669.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 24288.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23602.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21431.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21574.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24288.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21574.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18573.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 30620.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 46669.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23602.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 21431.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10572.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10572.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21431.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15487.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15601.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10572.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22860.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10572.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9429.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 21231.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21431.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10572.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 16573.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21431.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FOSPHENYTOIN 500 MG PE/10 ML INJECTION SOLUTION", "code_information": [{"code": "Q2009", "type": "HCPCS"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 13.41, "maximum": 247.1, "gross_charge": 68.6, "discounted_cash": 41.16, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 247.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 13.41, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 13.41, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 101.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 154.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 13.41, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 13.41, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 13.41, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 247.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 13.41, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 13.41, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 13.41, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 13.41, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 101.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 154.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 101.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 154.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 13.41, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 13.41, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 13.41, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FOSPHENYTOIN 100 MG PE/2 ML INJECTION SOLUTION", "code_information": [{"code": "Q2009", "type": "HCPCS"}], "drug_information": {"unit": 2, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 2.68, "maximum": 180.71, "gross_charge": 212.6, "discounted_cash": 127.56, "payers_information": [{"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 159.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 123.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2.68, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 159.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2.68, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2.68, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 159.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 20.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 30.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 175.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 160.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 138.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 180.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 160.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 159.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 155.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 20.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 30.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 180.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 175.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 159.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 157.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2.68, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2.68, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 170.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2.68, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 116.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 115.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 155.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 157.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 123.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 155.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2.68, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 159.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 138.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 115.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 115.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 129.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 170.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 49.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2.68, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 116.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 159.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 170.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 159.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2.68, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 160.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 138.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 155.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2.68, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 116.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 138.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 126.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 116.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 20.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 30.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 180.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 180.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 116.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 175.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2.68, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2.68, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 113.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 116.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 109.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 105.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 157.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 49.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 155.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 157.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 157.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 159.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FILGRASTIM-SNDZ 300 MCG/0.5 ML INJECTION SYRINGE", "code_information": [{"code": "Q5101", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "minimum": 104.7, "maximum": 792.29, "gross_charge": 932.1, "discounted_cash": 559.26, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 683.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 692.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 692.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 699.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 692.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 375.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 508.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 481.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 460.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 499.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 444.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 676.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 792.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 792.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 512.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 769.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 104.7, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 104.7, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 508.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 605.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 554.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 512.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 104.7, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 683.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 466.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 703.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 605.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 452.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 104.7, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 699.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 508.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 699.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 745.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 104.7, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 568.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 745.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 375.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 104.7, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 505.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 505.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 699.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 605.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 683.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 683.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 683.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 692.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 540.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 444.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 676.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 792.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 769.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 699.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 703.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 792.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 703.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 605.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 444.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 676.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 769.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 699.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 104.7, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 104.7, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 699.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 505.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 508.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 104.7, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 745.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 104.7, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 104.7, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 692.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 699.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 104.7, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 540.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 699.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "INFLIXIMAB-DYYB 100 MG INTRAVENOUS SOLUTION", "code_information": [{"code": "Q5103", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 242.2, "maximum": 1744.2, "gross_charge": 2052.0, "discounted_cash": 1231.2, "payers_information": [{"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1333.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1024.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1561.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1694.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1539.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 242.2, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 242.2, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1539.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1112.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1120.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 242.2, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1641.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 242.2, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 242.2, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1524.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1539.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 242.2, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1190.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1539.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1504.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 1524.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1524.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 1539.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1524.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 665.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1120.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1060.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1013.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1099.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1024.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1561.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1744.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 1744.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1128.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1694.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 242.2, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 242.2, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1120.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 1518.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1426.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 1333.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 242.2, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1504.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1249.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1549.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1333.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 995.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 242.2, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1539.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1120.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1539.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1641.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 242.2, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1539.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1641.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 665.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 242.2, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1112.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1112.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1539.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1333.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1504.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1504.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1504.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1524.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1190.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1024.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1561.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 1744.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1694.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1539.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1549.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1744.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1549.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "INFLIXIMAB-ABDA 100 MG INTRAVENOUS SOLUTION", "code_information": [{"code": "Q5104", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 277.54, "maximum": 1789.04, "gross_charge": 1996.15, "discounted_cash": 1197.69, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1463.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 1483.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1483.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 1497.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1483.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 846.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1089.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1032.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 986.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1069.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1173.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1789.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1696.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 1696.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1097.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1648.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 277.54, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 277.54, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1089.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 1477.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1387.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 1297.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 277.54, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1463.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 994.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1507.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1297.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 968.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 277.54, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1497.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1089.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1497.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1596.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 277.54, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1497.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1596.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 846.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 277.54, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1081.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1081.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1497.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1297.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1463.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1463.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1463.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1483.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1157.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1173.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1789.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 1696.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1648.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1497.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1507.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1696.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1507.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1297.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1173.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1789.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1648.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1497.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 277.54, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 277.54, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1497.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1081.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1089.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 277.54, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1596.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 277.54, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 277.54, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1483.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1497.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 277.54, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1157.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1497.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "EPOETIN ALFA-EPBX 2,000 UNIT/ML INJECTION SOLUTION", "code_information": [{"code": "Q5106", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 15.13, "maximum": 97.61, "gross_charge": 103.8, "discounted_cash": 62.28, "payers_information": [{"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 64.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 97.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 88.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 88.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 64.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 97.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 15.13, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 15.13, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 15.13, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 15.13, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 15.13, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 15.13, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 51.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 64.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 97.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 88.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 88.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 15.13, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 15.13, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 15.13, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 29.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 15.13, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 51.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 15.13, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 15.13, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "EPOETIN ALFA-EPBX 2,000 UNIT/ML INJECTION SOLUTION|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "Q5106", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 61.76, "maximum": 63.32, "gross_charge": 103.8, "discounted_cash": 62.28, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION", "code_information": [{"code": "Q5106", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 75.67, "maximum": 488.04, "gross_charge": 473.65, "discounted_cash": 284.19, "payers_information": [{"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 307.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 260.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 260.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 347.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 75.67, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 258.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 253.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 355.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 378.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 258.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 355.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 75.67, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 145.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 357.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 307.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 229.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 378.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 255.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 75.67, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 75.67, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 355.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 307.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 256.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 256.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 347.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 351.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 274.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 347.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 347.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 75.67, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 75.67, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 258.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 244.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 233.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 320.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 488.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 402.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 402.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 260.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 391.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 351.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 255.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 347.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 351.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 351.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 355.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 355.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 274.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 75.67, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 355.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 351.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 75.67, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 75.67, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 378.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 75.67, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 258.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 256.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 355.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 75.67, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 75.67, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 355.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 320.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 488.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 391.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 357.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 307.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 402.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 357.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 355.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 320.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 488.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 402.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 391.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "Q5106", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 281.82, "maximum": 288.93, "gross_charge": 473.65, "discounted_cash": 284.19, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 288.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 281.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "EPOETIN ALFA-EPBX 10,000 UNIT/ML IV SOLUTION (PEDIATRICS)", "code_information": [{"code": "Q5106", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 75.67, "maximum": 488.04, "gross_charge": 473.65, "discounted_cash": 284.19, "payers_information": [{"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 355.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 75.67, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 274.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 75.67, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 75.67, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 351.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 355.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 320.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 488.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 402.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 391.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 355.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 357.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 402.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 357.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 307.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 320.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 488.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 391.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 355.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 75.67, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 75.67, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 355.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 256.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 258.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 75.67, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 378.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 351.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 274.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 351.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 255.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 320.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 488.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 402.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 402.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 260.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 391.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 258.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 244.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 233.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 75.67, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 75.67, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 347.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 351.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 351.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 355.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 347.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 347.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 347.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 378.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 255.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 75.67, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 75.67, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 256.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 256.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 355.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 307.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 307.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 260.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 260.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 253.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 258.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 75.67, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 347.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 357.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 307.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 229.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 145.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 75.67, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 355.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 258.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 355.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 378.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "EPOETIN ALFA-EPBX 10,000 UNIT/ML IV SOLUTION (PEDIATRICS)|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "Q5106", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 281.82, "maximum": 288.93, "gross_charge": 473.65, "discounted_cash": 284.19, "payers_information": [{"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 281.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 288.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "EPOETIN ALFA-EPBX 2,000 UNIT/ML IV SOLUTION (PEDIATRICS)", "code_information": [{"code": "Q5106", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 15.13, "maximum": 97.61, "gross_charge": 103.8, "discounted_cash": 62.28, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 51.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 15.13, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 15.13, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 15.13, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 15.13, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 29.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 50.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 15.13, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 15.13, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 64.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 97.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 88.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 88.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 51.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 15.13, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 15.13, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 15.13, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 64.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 97.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 88.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 78.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 64.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 97.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 88.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 15.13, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 15.13, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 15.13, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "EPOETIN ALFA-EPBX 2,000 UNIT/ML IV SOLUTION (PEDIATRICS)|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "Q5106", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 61.76, "maximum": 63.32, "gross_charge": 103.8, "discounted_cash": 62.28, "payers_information": [{"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "BEVACIZUMAB-AWWB 25 MG/ML INTRAVENOUS SOLUTION", "code_information": [{"code": "Q5107", "type": "HCPCS"}], "drug_information": {"unit": 4, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 238.4, "maximum": 2650.39, "gross_charge": 3118.1, "discounted_cash": 1870.86, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2285.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 2316.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2316.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 2338.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2316.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 975.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1702.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1612.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1540.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1671.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1008.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1536.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 2650.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 2650.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1714.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2575.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 238.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 238.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1702.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 2307.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 2167.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 2026.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 238.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2285.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 921.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2354.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2026.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1512.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 238.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2338.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1702.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2338.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2494.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 238.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2338.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2494.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 975.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 238.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1690.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1690.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2338.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2026.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2285.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2285.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2285.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2316.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1808.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1008.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1536.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 2650.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2575.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2338.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2354.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2650.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2354.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2026.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1008.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1536.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2575.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2338.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 238.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 238.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2338.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1690.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1702.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 238.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2494.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 238.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 238.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2316.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2338.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 238.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1808.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2338.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PEGFILGRASTIM-JMDB 6 MG/0.6 ML SUBCUTANEOUS SYRINGE", "code_information": [{"code": "Q5108", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "minimum": 1186.45, "maximum": 7648.98, "gross_charge": 7344.0, "discounted_cash": 4406.4, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5383.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 5456.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5456.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 5508.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5456.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4206.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4009.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3796.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3627.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3936.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5018.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 7648.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 6242.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 6242.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 4039.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6066.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1186.45, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1186.45, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4009.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 4773.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4369.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 4039.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1186.45, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5383.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2755.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5544.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4773.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3561.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1186.45, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5508.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4009.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5508.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5875.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1186.45, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4479.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5875.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4206.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1186.45, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3980.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3980.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 5508.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4773.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5383.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5383.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5383.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5456.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4259.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5018.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 7648.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 6242.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6066.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5508.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5544.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6242.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5544.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4773.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5018.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 7648.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6066.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 5508.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1186.45, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1186.45, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5508.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3980.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4009.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1186.45, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5875.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1186.45, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1186.45, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5456.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5508.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1186.45, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4259.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5508.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PEGFILGRASTIM-CBQV 6 MG/0.6 ML SUBCUTANEOUS SYRINGE", "code_information": [{"code": "Q5111", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "minimum": 1943.87, "maximum": 12532.19, "gross_charge": 4771.85, "discounted_cash": 2863.11, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3497.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 3545.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3545.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 3578.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3545.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5517.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2605.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2467.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2357.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2557.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8222.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 12532.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 4056.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4056.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2624.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3941.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1943.87, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1943.87, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2605.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 3531.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 3316.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 3101.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1943.87, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3497.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5511.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3602.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3101.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2314.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1943.87, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3578.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2605.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3578.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3817.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1943.87, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3578.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3817.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5517.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1943.87, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2586.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2586.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3578.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3101.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3497.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3497.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3497.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3545.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2767.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8222.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 12532.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 4056.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3941.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3578.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3602.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4056.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3602.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3101.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 8222.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 12532.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3941.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3578.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1943.87, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1943.87, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3578.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2586.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2605.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1943.87, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3817.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1943.87, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1943.87, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3545.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3578.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1943.87, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2767.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3578.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "RITUXIMAB-ABBS 10 MG/ML INTRAVENOUS SOLUTION", "code_information": [{"code": "Q5115", "type": "HCPCS"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 301.45, "maximum": 10323.72, "gross_charge": 2429.15, "discounted_cash": 1457.49, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1780.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 1804.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1804.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 1821.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1804.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1053.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1326.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1255.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1200.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1302.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1275.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1943.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 2064.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 2064.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1336.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2006.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 301.45, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 301.45, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1326.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 1797.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1688.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 1578.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 301.45, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1780.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1116.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1834.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1578.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1178.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 301.45, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1821.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1326.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1821.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1943.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 301.45, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1821.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1943.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1053.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 301.45, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1316.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1316.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1821.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1578.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1780.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1780.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1780.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1804.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1408.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1275.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1943.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 2064.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2006.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1821.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1834.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2064.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1834.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1578.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1275.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1943.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2006.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1821.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 301.45, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 301.45, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1821.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1316.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1326.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 301.45, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1943.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 301.45, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 301.45, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1804.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1821.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 301.45, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1408.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1821.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "RITUXIMAB-ABBS 10 MG/ML INTRAVENOUS SOLUTION", "code_information": [{"code": "Q5115", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 301.45, "maximum": 10323.72, "gross_charge": 12145.55, "discounted_cash": 7287.33, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8902.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 9024.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 9024.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 9109.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 9024.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5269.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6631.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6279.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5999.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6510.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6376.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 9718.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 10323.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 10323.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 6680.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10032.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1507.25, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1507.25, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6631.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 8987.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 8441.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 7894.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1507.25, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8902.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5580.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9169.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7894.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5890.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1507.25, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9109.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6631.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9109.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9716.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1507.25, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9109.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9716.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5269.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1507.25, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6582.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6582.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 9109.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7894.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8902.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8902.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8902.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 9024.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 7044.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6376.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 9718.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 10323.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10032.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9109.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9169.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10323.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9169.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7894.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 6376.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 9718.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10032.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 9109.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1507.25, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1507.25, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9109.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6582.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6631.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1507.25, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9716.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1507.25, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1507.25, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 9024.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9109.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1507.25, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 7044.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9109.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "RITUXIMAB-PVVR 10 MG/ML INTRAVENOUS SOLUTION", "code_information": [{"code": "Q5119", "type": "HCPCS"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 132.7, "maximum": 8526.61, "gross_charge": 2006.35, "discounted_cash": 1203.81, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1470.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 1490.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1490.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 1504.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1490.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 895.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1095.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1037.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 991.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1075.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 561.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 855.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1705.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 1705.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1103.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1657.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 132.7, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 132.7, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1095.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 1484.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1394.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 1304.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 132.7, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1470.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 946.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1514.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1304.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 973.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 132.7, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1504.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1095.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1504.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1605.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 132.7, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1504.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1605.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 895.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 132.7, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1087.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1087.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1504.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1304.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1470.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1470.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1470.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1490.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1163.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 561.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 855.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 1705.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1657.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1504.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1514.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1705.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1514.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1304.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 561.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 855.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1657.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1504.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 132.7, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 132.7, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1504.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1087.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1095.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 132.7, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1605.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 132.7, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 132.7, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1490.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1504.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 132.7, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1163.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1504.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "RITUXIMAB-PVVR 10 MG/ML INTRAVENOUS SOLUTION", "code_information": [{"code": "Q5119", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 132.7, "maximum": 8526.61, "gross_charge": 10031.3, "discounted_cash": 6018.78, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7352.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 7453.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7453.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 7523.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7453.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4478.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5477.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5186.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4955.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5376.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2806.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 4277.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 8526.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 8526.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 5517.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8285.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 663.5, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 663.5, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5477.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 7423.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 6971.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 6520.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 663.5, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7352.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4731.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7573.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6520.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4865.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 663.5, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7523.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5477.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7523.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8025.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 663.5, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7523.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8025.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4478.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 663.5, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5436.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5436.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 7523.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6520.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7352.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7352.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7352.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7453.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 5818.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2806.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 4277.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 8526.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8285.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7523.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7573.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8526.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7573.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6520.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 2806.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 4277.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8285.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 7523.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 663.5, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 663.5, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7523.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5436.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5477.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 663.5, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8025.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 663.5, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 663.5, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7453.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7523.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 663.5, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 5818.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7523.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "INFLIXIMAB-AXXQ 100 MG INTRAVENOUS SOLUTION", "code_information": [{"code": "Q5121", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 238.11, "maximum": 1647.3, "gross_charge": 1938.0, "discounted_cash": 1162.8, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1420.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 1439.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1439.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 1453.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1439.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 706.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1058.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1001.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 957.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1038.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1007.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1535.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1647.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 1647.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1065.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1600.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 238.11, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 238.11, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1058.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 1434.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1346.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 1259.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 238.11, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1420.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "fee schedule", "standard_charge_dollar": 660.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1463.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1259.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 939.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 238.11, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1453.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1058.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1453.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1550.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 238.11, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1453.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1550.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 706.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 238.11, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1050.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1050.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1453.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1259.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1420.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1420.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1420.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1439.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1124.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1007.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1535.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 1647.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1600.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1453.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1463.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1647.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1463.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1259.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1007.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 1535.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1600.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1453.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 238.11, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 238.11, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1453.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1050.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1058.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 238.11, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1550.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 238.11, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 238.11, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1439.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1453.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 238.11, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1124.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1453.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FILGRASTIM-AYOW 300 MCG/0.5 ML SUBCUTANEOUS SYRINGE", "code_information": [{"code": "Q5125", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "minimum": 101.4, "maximum": 657.59, "gross_charge": 336.6, "discounted_cash": 201.96, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 246.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 250.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 250.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 252.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 250.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 417.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 183.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 174.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 166.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 180.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 431.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 657.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 286.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 286.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 185.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 278.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 218.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 185.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 185.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 101.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 101.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 183.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 101.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 246.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 168.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 254.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 218.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 163.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 101.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 252.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 252.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 269.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 183.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 101.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 252.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 269.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 417.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 182.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 182.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 252.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 218.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 101.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 246.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 246.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 250.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 195.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 431.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 657.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 286.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 278.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 246.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 252.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 254.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 286.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 254.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 218.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 431.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 657.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 278.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 252.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 101.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 101.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 252.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 182.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 183.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 101.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 269.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 101.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 101.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 250.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 252.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 101.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 195.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 252.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FILGRASTIM-AYOW 300 MCG/0.5 ML SUBCUTANEOUS SYRINGE|DISCARDED DRUG NOT ADMINISTERED", "code_information": [{"code": "Q5125", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "minimum": 218.79, "maximum": 249.08, "gross_charge": 336.6, "discounted_cash": 201.96, "payers_information": [{"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 249.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 233.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 218.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FILGRASTIM-AYOW SYRINGE 20 MCG/ML (PEDIATRICS)", "code_information": [{"code": "Q5125", "type": "HCPCS"}], "drug_information": {"unit": 15, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 101.4, "maximum": 657.59, "gross_charge": 225.4, "discounted_cash": 135.24, "payers_information": [{"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 169.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 130.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 101.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 169.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 167.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 101.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 101.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 180.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 101.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 123.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 122.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 169.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 101.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 101.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 169.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 431.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 657.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 186.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 170.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 146.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 191.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 170.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 169.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 165.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 431.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 657.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 191.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 186.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 165.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 167.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 130.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 165.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 101.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 169.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 146.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 122.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 122.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 169.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 180.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 417.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 101.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 123.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 169.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 180.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 169.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 101.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 170.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 146.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 109.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 165.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 146.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 123.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 123.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 101.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 123.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 101.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 101.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "fee schedule", "standard_charge_dollar": 431.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "fee schedule", "standard_charge_dollar": 657.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 191.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 191.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 123.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 186.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 123.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 116.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 111.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 167.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 417.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 165.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 167.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 167.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 169.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ADALIMUMAB-FKJP 20 MG/0.4 ML SUBCUTANEOUS SYRINGE KIT", "code_information": [{"code": "Q5140", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 2441.72, "maximum": 10732.84, "gross_charge": 13416.05, "discounted_cash": 8049.63, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9833.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5890.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6627.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7191.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7378.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2763.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2441.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 7378.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9833.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6708.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10732.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10732.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5890.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3139.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7271.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 10062.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9833.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10732.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 7781.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9833.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 7781.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9833.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 10062.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3139.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3139.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7271.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3139.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ADALIMUMAB-FKJP 40 MG/0.8 ML SUBCUTANEOUS SYRINGE KIT", "code_information": [{"code": "Q5140", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 2441.72, "maximum": 11781.2, "gross_charge": 13416.05, "discounted_cash": 8049.63, "payers_information": [{"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3139.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7271.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3139.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3139.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 10062.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9833.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9833.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 7781.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 7781.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10732.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9833.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 10062.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7271.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3139.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10732.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11781.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10732.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6708.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9833.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 7378.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2763.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2441.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7378.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7191.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6627.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 11781.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9833.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "IOTHALAMATE MEGLUMINE 17.2 % URETHRAL SOLUTION", "code_information": [{"code": "Q9958", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "minimum": 0.07, "maximum": 0.24, "gross_charge": 0.15, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "IOTHALAMATE MEGLUMINE 43 % INTRAVENOUS SOLUTION", "code_information": [{"code": "Q9960", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "minimum": 0.29, "maximum": 0.51, "gross_charge": 0.6, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "IOTHALAMATE MEGLUMINE 60 % INJECTION SOLUTION", "code_information": [{"code": "Q9961", "type": "HCPCS"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.17, "maximum": 147.0, "gross_charge": 0.35, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "IOTHALAMATE MEGLUMINE 60 % INJECTION SOLUTION", "code_information": [{"code": "Q9961", "type": "HCPCS"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.17, "maximum": 147.0, "gross_charge": 3.25, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 9.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "IOTHALAMATE MEGLUMINE 60 % INJECTION SOLUTION", "code_information": [{"code": "Q9961", "type": "HCPCS"}], "drug_information": {"unit": 100, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.17, "maximum": 147.0, "gross_charge": 35.4, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 98.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "IOTHALAMATE MEGLUMINE 60 % INJECTION SOLUTION", "code_information": [{"code": "Q9961", "type": "HCPCS"}], "drug_information": {"unit": 150, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.17, "maximum": 147.0, "gross_charge": 48.7, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 147.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "IOTHALAMATE MEGLUMINE 60 % INJECTION SOLUTION", "code_information": [{"code": "Q9961", "type": "HCPCS"}], "drug_information": {"unit": 30, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.17, "maximum": 147.0, "gross_charge": 13.75, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 29.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "IOTHALAMATE MEGLUMINE 60 % INJECTION SOLUTION", "code_information": [{"code": "Q9961", "type": "HCPCS"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.17, "maximum": 147.0, "gross_charge": 1.65, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "IOTHALAMATE MEGLUMINE 60 % INJECTION SOLUTION", "code_information": [{"code": "Q9961", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.17, "maximum": 147.0, "gross_charge": 16.25, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 49.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION", "code_information": [{"code": "Q9963", "type": "HCPCS"}], "drug_information": {"unit": 30, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.38, "maximum": 22.2, "gross_charge": 14.25, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 22.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION", "code_information": [{"code": "Q9963", "type": "HCPCS"}], "drug_information": {"unit": 6, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.38, "maximum": 22.2, "gross_charge": 2.85, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 4.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "IOHEXOL 180 MG IODINE/ML INTRATHECAL SOLUTION", "code_information": [{"code": "Q9965", "type": "HCPCS"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 52.28, "maximum": 91.63, "gross_charge": 107.8, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 60.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "IOVERSOL 240 MG IODINE/ML INTRAVENOUS SOLUTION", "code_information": [{"code": "Q9966", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "minimum": 0.15, "maximum": 1.52, "gross_charge": 0.3, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "IODIXANOL 270 MG IODINE/ML INTRAVENOUS SOLUTION", "code_information": [{"code": "Q9966", "type": "HCPCS"}], "drug_information": {"unit": 200, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 91.57, "maximum": 304.0, "gross_charge": 188.8, "discounted_cash": 113.28, "payers_information": [{"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 141.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 109.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 141.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 140.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 151.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 141.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 141.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 123.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 155.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 142.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 122.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 160.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 142.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 141.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 123.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 160.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 155.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 140.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 109.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 141.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 122.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 151.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 304.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 141.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 151.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 141.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 132.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 142.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 122.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 122.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 140.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 97.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 114.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 123.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 160.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 160.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 155.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 140.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 134.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 140.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 140.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 141.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION", "code_information": [{"code": "Q9967", "type": "HCPCS"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 5.1, "maximum": 969.17, "gross_charge": 108.2, "payers_information": [{"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 5.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 86.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION", "code_information": [{"code": "Q9967", "type": "HCPCS"}], "drug_information": {"unit": 150, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 5.1, "maximum": 969.17, "gross_charge": 357.1, "payers_information": [{"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 264.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 248.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 232.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 194.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 249.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 269.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 232.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 173.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 265.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 267.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 207.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 267.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 194.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 285.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 303.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 267.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 267.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 193.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 267.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 232.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 265.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 207.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 217.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 234.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 303.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 294.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 267.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 269.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 269.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 232.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 217.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 234.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 294.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 266.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 265.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 254.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 267.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 194.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 267.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 285.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 76.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 267.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 285.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 193.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 193.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 265.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 265.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 267.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 194.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 184.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 176.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 217.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 234.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 303.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 303.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 196.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 294.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION", "code_information": [{"code": "Q9967", "type": "HCPCS"}], "drug_information": {"unit": 30, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 5.1, "maximum": 969.17, "gross_charge": 108.9, "payers_information": [{"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 66.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION", "code_information": [{"code": "Q9967", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 5.1, "maximum": 969.17, "gross_charge": 107.4, "payers_information": [{"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 88.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 88.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 81.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 88.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 25.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 85.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION", "code_information": [{"code": "Q9967", "type": "HCPCS"}], "drug_information": {"unit": 500, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 5.1, "maximum": 969.17, "gross_charge": 1140.2, "payers_information": [{"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 843.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 792.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 741.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 622.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 798.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 860.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 741.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 553.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 847.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 855.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 661.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 855.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 694.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 747.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 969.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 969.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 627.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 941.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 622.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 912.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 969.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 855.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 855.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 617.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 855.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 741.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 847.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 661.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 694.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 747.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 969.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 941.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 855.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 860.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 860.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 741.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 694.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 747.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 941.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 849.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 847.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 812.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 855.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 622.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 855.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 912.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 255.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 855.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 912.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 617.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 617.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 847.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 847.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 855.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 622.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 589.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 563.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "IOVERSOL 320 MG IODINE/ML INTRAVENOUS SOLUTION", "code_information": [{"code": "Q9967", "type": "HCPCS"}], "drug_information": {"unit": 100, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 6.72, "maximum": 102.0, "gross_charge": 30.4, "payers_information": [{"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 51.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "IOVERSOL 320 MG IODINE/ML INTRAVENOUS SOLUTION", "code_information": [{"code": "Q9967", "type": "HCPCS"}], "drug_information": {"unit": 150, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 6.72, "maximum": 102.0, "gross_charge": 43.85, "payers_information": [{"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 76.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "IOVERSOL 320 MG IODINE/ML INTRAVENOUS SOLUTION", "code_information": [{"code": "Q9967", "type": "HCPCS"}], "drug_information": {"unit": 20, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 6.72, "maximum": 102.0, "gross_charge": 28.35, "payers_information": [{"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 10.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "IOVERSOL 320 MG IODINE/ML INTRAVENOUS SOLUTION", "code_information": [{"code": "Q9967", "type": "HCPCS"}], "drug_information": {"unit": 200, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 6.72, "maximum": 102.0, "gross_charge": 58.45, "payers_information": [{"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 102.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "IOVERSOL 320 MG IODINE/ML INTRAVENOUS SOLUTION", "code_information": [{"code": "Q9967", "type": "HCPCS"}], "drug_information": {"unit": 30, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 6.72, "maximum": 102.0, "gross_charge": 13.85, "payers_information": [{"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "IOVERSOL 320 MG IODINE/ML INTRAVENOUS SOLUTION", "code_information": [{"code": "Q9967", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 6.72, "maximum": 102.0, "gross_charge": 18.3, "payers_information": [{"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 25.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "IOVERSOL 350 MG IODINE/ML INTRAVENOUS SOLUTION", "code_information": [{"code": "Q9967", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "minimum": 0.15, "maximum": 0.51, "gross_charge": 0.4, "discounted_cash": 0.24, "payers_information": [{"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 0.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "IOVERSOL 350 MG IODINE/ML INTRAVENOUS SYRINGE", "code_information": [{"code": "Q9967", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 10.89, "maximum": 28.73, "gross_charge": 22.45, "discounted_cash": 13.47, "payers_information": [{"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 25.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 25.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 25.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 25.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION", "code_information": [{"code": "Q9967", "type": "HCPCS"}], "drug_information": {"unit": 500, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 228.92, "maximum": 401.2, "gross_charge": 472.0, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 350.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 350.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 354.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 257.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 244.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 233.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 350.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 336.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 356.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 306.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 228.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 354.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 257.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 354.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 377.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 255.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 354.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 377.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 255.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 255.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 351.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 257.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 401.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 354.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 354.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 255.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 354.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 306.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 350.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 273.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 287.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 309.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 401.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 389.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 354.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 356.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 356.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 306.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 287.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 309.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 389.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 287.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 309.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 401.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 401.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 259.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 389.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 349.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 328.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 306.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 257.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 330.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 350.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 377.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 354.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 273.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 354.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "IOVERSOL 320 MG IODINE/ML INTRAVENOUS SYRINGE", "code_information": [{"code": "Q9967", "type": "HCPCS"}], "drug_information": {"unit": 125, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 9.51, "maximum": 63.75, "gross_charge": 52.4, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 63.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "IOVERSOL 320 MG IODINE/ML INTRAVENOUS SYRINGE", "code_information": [{"code": "Q9967", "type": "HCPCS"}], "drug_information": {"unit": 30, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 9.51, "maximum": 63.75, "gross_charge": 19.6, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "IOVERSOL 320 MG IODINE/ML INTRAVENOUS SYRINGE", "code_information": [{"code": "Q9967", "type": "HCPCS"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 9.51, "maximum": 63.75, "gross_charge": 34.25, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 25.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "IOVERSOL 320 MG IODINE/ML INTRAVENOUS SYRINGE", "code_information": [{"code": "Q9967", "type": "HCPCS"}], "drug_information": {"unit": 75, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 9.51, "maximum": 63.75, "gross_charge": 39.4, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 38.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ISOSULFAN BLUE 1 % SUBCUTANEOUS SOLUTION", "code_information": [{"code": "Q9968", "type": "HCPCS"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 490.4, "maximum": 3469.4, "gross_charge": 4081.65, "discounted_cash": 2448.99, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2991.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_dollar": 3032.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3032.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_dollar": 3061.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3032.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1328.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2228.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2110.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2016.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2187.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2485.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2677.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 3469.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 3469.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 2244.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3371.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 490.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 490.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2228.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_dollar": 2653.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 2244.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_dollar": 2244.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 490.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2991.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2040.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3081.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2653.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1979.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 490.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3061.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2228.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3061.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3265.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 490.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2489.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3265.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_dollar": 1328.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 490.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2212.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2212.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3061.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2653.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2991.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2991.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2991.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3032.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2367.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2485.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2677.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_dollar": 3469.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3371.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3061.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3081.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3469.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3081.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2653.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2485.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2677.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3371.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 3061.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 490.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 490.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3061.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2212.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2228.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 490.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3265.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 490.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 490.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 3032.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3061.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 490.4, "count": "0", "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2367.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3061.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ENTERAL PUMP ACCESSORY FOR FAT HYDROLYSIS CARTRIDGE", "code_information": [{"code": "Q9994", "type": "HCPCS"}], "drug_information": {"unit": 30, "type": "UN"}, "standard_charges": [{"setting": "outpatient", "minimum": 3569.26, "maximum": 15689.04, "gross_charge": 19611.3, "discounted_cash": 11766.78, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15492.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13982.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9687.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14610.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_dollar": 10786.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4039.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3569.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_dollar": 10786.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15492.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15689.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15689.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13982.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4589.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10629.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 14708.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15492.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15492.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15492.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 11374.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_dollar": 14708.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4589.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4589.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10629.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4589.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15689.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 11374.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FELBAMATE 600 MG/5 ML ORAL SUSPENSION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 237, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 167.62, "maximum": 736.8, "gross_charge": 921.0, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 656.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 189.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 167.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 215.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 215.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 215.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 534.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 736.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 656.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 215.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 534.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "GRISEOFULVIN MICROSIZE 125 MG/5 ML ORAL SUSPENSION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 118, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 23.78, "maximum": 127.04, "gross_charge": 130.65, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 104.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 75.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "GRISEOFULVIN MICROSIZE 125 MG/5 ML ORAL SUSPENSION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 120, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 23.78, "maximum": 127.04, "gross_charge": 158.8, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 113.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 113.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 37.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HYDROMORPHONE 1 MG/ML ORAL LIQUID", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.23, "maximum": 1.0, "gross_charge": 1.25, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LACOSAMIDE 10 MG/ML ORAL SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 7.8, "maximum": 34.28, "gross_charge": 42.85, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MORPHINE CONCENTRATE 100 MG/5 ML (20 MG/ML) ORAL SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 15, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 6.28, "maximum": 27.6, "gross_charge": 34.5, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "NITROFURANTOIN 25 MG/5 ML ORAL SUSPENSION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 230, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 216.51, "maximum": 951.68, "gross_charge": 1189.6, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 848.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 245.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 216.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 278.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 278.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 278.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 689.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 951.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 848.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 689.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 278.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "GLYCOPYRROLATE 1 MG/5 ML (0.2 MG/ML) ORAL SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 473, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 163.91, "maximum": 720.48, "gross_charge": 900.6, "discounted_cash": 540.36, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 522.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 210.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 210.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 210.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 185.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 163.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 642.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 210.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 522.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 720.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 642.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OXYBUTYNIN CHLORIDE 5 MG/5 ML ORAL SYRUP", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.12, "maximum": 0.52, "gross_charge": 0.65, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "RUFINAMIDE 40 MG/ML ORAL SUSPENSION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 460, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 585.54, "maximum": 2573.8, "gross_charge": 3217.25, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1866.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 752.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 752.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 752.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 662.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 585.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2293.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 752.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1866.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2573.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2293.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "POTAS AND SOD CITRATE-CITRIC ACID 550 MG-500 MG-334 MG/5 ML ORAL SOLN", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 473, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 25.32, "maximum": 111.28, "gross_charge": 139.1, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 111.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OSELTAMIVIR 6 MG/ML ORAL SUSPENSION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 100, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 7.94, "maximum": 306.92, "gross_charge": 80.75, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 57.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OSELTAMIVIR 6 MG/ML ORAL SUSPENSION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 7.94, "maximum": 306.92, "gross_charge": 43.6, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OSELTAMIVIR 6 MG/ML ORAL SUSPENSION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 60, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 7.94, "maximum": 306.92, "gross_charge": 383.65, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 222.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 79.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 273.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 89.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 222.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 306.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 273.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PYRIDOSTIGMINE BROMIDE 60 MG/5 ML ORAL SYRUP", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 473, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 196.8, "maximum": 865.04, "gross_charge": 1081.3, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 770.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 222.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 196.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 253.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 253.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 253.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 627.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 865.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 770.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 627.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 253.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SUCRALFATE 100 MG/ML ORAL SUSPENSION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.36, "maximum": 14.76, "gross_charge": 18.45, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "VANCOMYCIN 50 MG/ML ORAL SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 150, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 67.95, "maximum": 298.68, "gross_charge": 373.35, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 216.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 266.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 76.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 298.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 266.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 216.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ZIDOVUDINE 10 MG/ML ORAL SYRUP", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 240, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 21.1, "maximum": 92.76, "gross_charge": 115.95, "discounted_cash": 69.57, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 92.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "METHYLPHENIDATE 5 MG/ML (25 MG/5 ML) ORAL SUSP,EXTENDED RELEASE 24 HR", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 21.16, "maximum": 93.0, "gross_charge": 116.25, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 93.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 82.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CLOBAZAM 2.5 MG/ML ORAL SUSPENSION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 4, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 30.42, "maximum": 133.72, "gross_charge": 167.15, "payers_information": [{"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 119.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 96.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 133.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 119.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 96.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SILDENAFIL (PULMONARY HYPERTENSION) 10 MG/ML ORAL POWDR FOR SUSPENSION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 112, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 53.66, "maximum": 235.88, "gross_charge": 294.85, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 171.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 210.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 171.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 235.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 210.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SOTALOL 5 MG/ML ORAL SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 250, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 199.84, "maximum": 1618.96, "gross_charge": 1098.0, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 636.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 256.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 878.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 782.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 256.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 256.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 256.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 226.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 199.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 782.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 636.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SOTALOL 5 MG/ML ORAL SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 480, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 199.84, "maximum": 1618.96, "gross_charge": 2023.7, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1173.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 473.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1618.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1442.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 473.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 473.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 473.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 416.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 368.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1442.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1173.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ARGININE (L-ARGININE) (BULK) 100 % POWDER", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 100, "type": "GR"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.74, "maximum": 16.44, "gross_charge": 20.55, "discounted_cash": 12.33, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SODIUM CITRATE-CITRIC ACID 500 MG-334 MG/5 ML ORAL SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 473, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 17.56, "maximum": 77.2, "gross_charge": 96.5, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "AZITHROMYCIN 200 MG/5 ML ORAL SUSPENSION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 15, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 7.84, "maximum": 54.84, "gross_charge": 43.1, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "AZITHROMYCIN 200 MG/5 ML ORAL SUSPENSION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 22, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 7.84, "maximum": 54.84, "gross_charge": 68.55, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "AZITHROMYCIN 200 MG/5 ML ORAL SUSPENSION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 30, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 7.84, "maximum": 54.84, "gross_charge": 45.25, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LAMIVUDINE 10 MG/ML ORAL SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 240, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 31.32, "maximum": 137.68, "gross_charge": 172.1, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 137.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 122.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 122.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SODIUM HYPOCHLORITE 0.25 % SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 473, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.49, "maximum": 15.36, "gross_charge": 19.2, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PEDIATRIC MULTIVITAMIN NO.128-VITAMIN K 500 MCG/ML ORAL LIQUID", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 60, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 17.57, "maximum": 77.24, "gross_charge": 96.55, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 56.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "BRIVARACETAM 10 MG/ML ORAL SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 16.34, "maximum": 71.84, "gross_charge": 89.8, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 64.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PERAMPANEL 0.5 MG/ML ORAL SUSPENSION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 4, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 12.42, "maximum": 54.6, "gross_charge": 68.25, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 54.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "RISPERIDONE 1 MG/ML ORAL SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "standard_charges": [{"setting": "outpatient", "minimum": 0.12, "maximum": 300.44, "gross_charge": 0.65, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "RISPERIDONE 1 MG/ML ORAL SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.12, "maximum": 300.44, "gross_charge": 2.6, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "RISPERIDONE 1 MG/ML ORAL SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 2, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.12, "maximum": 300.44, "gross_charge": 5.15, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "RISPERIDONE 1 MG/ML ORAL SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 30, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.12, "maximum": 300.44, "gross_charge": 375.55, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 300.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 267.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 217.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 217.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 87.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 77.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 267.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SODIUM POLYSTYRENE SULFONATE 15 GRAM-SORBITOL 20 GRAM/60 ML ORAL SUSP", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 473, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 14.07, "maximum": 351.92, "gross_charge": 439.9, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 255.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 313.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 351.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 313.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 255.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SODIUM POLYSTYRENE SULFONATE 15 GRAM-SORBITOL 20 GRAM/60 ML ORAL SUSP", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 60, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 14.07, "maximum": 351.92, "gross_charge": 77.3, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ENALAPRIL MALEATE 1 MG/ML ORAL SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 150, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 106.47, "maximum": 468.0, "gross_charge": 585.0, "discounted_cash": 351.0, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 339.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 106.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 417.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 339.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 468.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 417.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ONDANSETRON HCL 4 MG/5 ML ORAL SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.67, "maximum": 7.32, "gross_charge": 9.15, "discounted_cash": 5.49, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CITRULLINE (BULK) POWDER", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 500, "type": "GR"}, "standard_charges": [{"setting": "outpatient", "minimum": 46.41, "maximum": 204.0, "gross_charge": 255.0, "discounted_cash": 153.0, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 147.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 204.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 181.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 147.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 181.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "POTASSIUM IODIDE 65 MG/ML ORAL DROPS", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 30, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 10.16, "maximum": 44.64, "gross_charge": 55.8, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SPIRONOLACTONE 25 MG/5 ML ORAL SUSPENSION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 473, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 476.49, "maximum": 2094.48, "gross_charge": 2618.1, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1518.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 612.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2094.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1866.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1518.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 612.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 612.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 612.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 539.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 476.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1866.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ITRACONAZOLE 10 MG/ML ORAL SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 150, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 83.61, "maximum": 367.52, "gross_charge": 459.4, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 266.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 327.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 94.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 83.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 107.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 107.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 107.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 107.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 266.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 367.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 327.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CANNABIDIOL 100 MG/ML ORAL SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 100, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 614.65, "maximum": 2701.76, "gross_charge": 3377.2, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2701.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2407.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1958.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 790.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 790.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 790.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 790.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 695.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 614.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2407.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1958.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MORPHINE CONCENTRATE 10 MG/0.5 ML ORAL SYRINGE", "code_information": [{"code": "2500003", "type": "CDM"}], "standard_charges": [{"setting": "outpatient", "minimum": 0.22, "maximum": 0.96, "gross_charge": 1.2, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "AMLODIPINE BENZOATE 1 MG/ML ORAL SUSPENSION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 150, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 239.56, "maximum": 1053.0, "gross_charge": 1316.25, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1053.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 938.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 763.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 308.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 763.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 308.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 308.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 308.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 271.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 239.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 938.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TOPIRAMATE 25 MG/ML ORAL SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 473, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 316.15, "maximum": 1389.68, "gross_charge": 1737.1, "payers_information": [{"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 406.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 406.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 406.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1238.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 357.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 316.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1007.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 406.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1007.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1389.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1238.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "BACLOFEN 5 MG/ML ORAL SUSPENSION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 120, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 271.84, "maximum": 1194.92, "gross_charge": 1493.65, "discounted_cash": 896.19, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 866.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 307.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 271.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1064.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 349.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 349.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 349.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1194.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1064.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 866.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 349.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SODIUM CHLORIDE 4 MEQ/ML (234 MG/ML) ORAL SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 400, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 3.31, "maximum": 14.56, "gross_charge": 18.2, "payers_information": [{"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "SULFAMETHOXAZOLE 200 MG-TRIMETHOPRIM 40 MG/5 ML ORAL SUSPENSION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 20, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.9, "maximum": 3.96, "gross_charge": 4.95, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "POTASSIUM CITRATE-CITRIC ACID 1,100 MG-334 MG/5 ML ORAL SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 473, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 30.74, "maximum": 135.12, "gross_charge": 168.9, "payers_information": [{"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 30.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 97.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 97.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 135.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 120.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "NEVIRAPINE 50 MG/5 ML ORAL SUSPENSION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 20, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 10.96, "maximum": 48.16, "gross_charge": 60.2, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MIDAZOLAM 2 MG/ML ORAL SYRUP", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 118, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 2.0, "maximum": 160.92, "gross_charge": 201.15, "payers_information": [{"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 116.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 160.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 143.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 143.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 36.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 116.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MIDAZOLAM 2 MG/ML ORAL SYRUP", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 2.0, "maximum": 160.92, "gross_charge": 11.0, "payers_information": [{"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ABACAVIR 20 MG/ML ORAL SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 240, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 62.64, "maximum": 275.36, "gross_charge": 344.2, "discounted_cash": 206.52, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 199.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 70.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 62.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 245.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 275.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 245.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 199.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 80.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DIPHENOXYLATE-ATROPINE 2.5 MG-0.025 MG/5 ML ORAL LIQUID", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 60, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 40.48, "maximum": 177.92, "gross_charge": 222.4, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 128.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 158.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 40.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 128.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 177.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 158.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "AMOXICILLIN 400 MG/5 ML ORAL SUSPENSION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 100, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 2.63, "maximum": 11.56, "gross_charge": 14.45, "payers_information": [{"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "GABAPENTIN 250 MG/5 ML ORAL SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 473, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 45.63, "maximum": 200.56, "gross_charge": 250.7, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 145.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 178.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 145.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 200.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 178.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "OXCARBAZEPINE 300 MG/5 ML (60 MG/ML) ORAL SUSPENSION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 250, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 52.72, "maximum": 231.72, "gross_charge": 289.65, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 231.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 206.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 168.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 168.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 52.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 206.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "AMOXICILLIN 600 MG-POTASSIUM CLAVULANATE 42.9 MG/5 ML ORAL SUSPENSION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 125, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.48, "maximum": 68.48, "gross_charge": 57.7, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 33.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "AMOXICILLIN 600 MG-POTASSIUM CLAVULANATE 42.9 MG/5 ML ORAL SUSPENSION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 200, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.48, "maximum": 68.48, "gross_charge": 84.0, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 67.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 59.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "AMOXICILLIN 600 MG-POTASSIUM CLAVULANATE 42.9 MG/5 ML ORAL SUSPENSION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.48, "maximum": 68.48, "gross_charge": 2.65, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "AMOXICILLIN 600 MG-POTASSIUM CLAVULANATE 42.9 MG/5 ML ORAL SUSPENSION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 75, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.48, "maximum": 68.48, "gross_charge": 85.6, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.63, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 68.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 61.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FUROSEMIDE 10 MG/ML ORAL SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 120, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 7.42, "maximum": 32.6, "gross_charge": 40.75, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 32.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 100, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 5.03, "maximum": 22.12, "gross_charge": 27.65, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "GUAIFENESIN 100 MG/5 ML ORAL LIQUID", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.06, "maximum": 4.68, "gross_charge": 5.85, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.37, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HALOPERIDOL LACTATE 2 MG/ML ORAL CONCENTRATE", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 2.48, "maximum": 10.88, "gross_charge": 13.6, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.13, "maximum": 1.12, "gross_charge": 1.4, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.13, "maximum": 1.12, "gross_charge": 0.7, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HYDROXYZINE HCL 10 MG/5 ML ORAL SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 473, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 39.78, "maximum": 174.84, "gross_charge": 218.55, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 155.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 45.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 126.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 126.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 174.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 155.83, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 6.53, "maximum": 28.72, "gross_charge": 35.9, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 28.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "VORICONAZOLE 200 MG/5 ML (40 MG/ML) ORAL SUSPENSION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 75, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 230.35, "maximum": 1012.52, "gross_charge": 1265.65, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 734.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 296.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1012.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 902.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 902.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 260.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 230.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 296.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 296.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 296.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 734.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 120, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 14.88, "maximum": 65.4, "gross_charge": 81.75, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 65.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 58.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 47.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ETHOSUXIMIDE 250 MG/5 ML ORAL SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 473, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 21.69, "maximum": 121.76, "gross_charge": 119.2, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 95.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 69.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ETHOSUXIMIDE 250 MG/5 ML ORAL SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 474, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 21.69, "maximum": 121.76, "gross_charge": 152.2, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 88.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 121.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 108.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 88.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "INDOMETHACIN 25 MG/5 ML ORAL SUSPENSION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 237, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 622.69, "maximum": 2737.08, "gross_charge": 3421.35, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1984.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 800.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 800.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 800.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 704.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 622.69, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2439.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2737.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2439.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 800.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1984.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ISONIAZID 50 MG/5 ML ORAL SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 20, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 6.66, "maximum": 432.36, "gross_charge": 36.6, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 7.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ISONIAZID 50 MG/5 ML ORAL SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 30, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 6.66, "maximum": 432.36, "gross_charge": 48.0, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 27.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ISONIAZID 50 MG/5 ML ORAL SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 473, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 6.66, "maximum": 432.36, "gross_charge": 540.45, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 313.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 385.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 111.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 98.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 126.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 126.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 126.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 432.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 385.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 313.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 126.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LIDOCAINE HCL 4 % (40 MG/ML) MUCOSAL SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 50, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 5.34, "maximum": 23.48, "gross_charge": 29.35, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.87, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LORAZEPAM 2 MG/ML ORAL CONCENTRATE", "code_information": [{"code": "2500003", "type": "CDM"}], "standard_charges": [{"setting": "outpatient", "minimum": 0.4, "maximum": 1.76, "gross_charge": 2.2, "payers_information": [{"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.57, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "METHADONE 5 MG/5 ML ORAL SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.51, "maximum": 6.64, "gross_charge": 8.3, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ATENOLOL ORAL SUSPENSION 2 MG/ML", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 100, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.24, "maximum": 1.04, "gross_charge": 1.3, "payers_information": [{"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.75, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "METOPROLOL TARTRATE SUSPENSION 10 MG/ML", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 60, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.42, "maximum": 1.84, "gross_charge": 2.3, "payers_information": [{"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LEUCOVORIN ORAL SOLUTION 10 MG/ML", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 12.52, "maximum": 55.04, "gross_charge": 68.8, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.17, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 39.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CARBAMAZEPINE 100 MG/5 ML ORAL SUSPENSION (SO)", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 450, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 41.28, "maximum": 181.44, "gross_charge": 226.8, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 181.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 161.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 131.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 131.54, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 46.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 41.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 161.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LACTULOSE 10 GRAM/15 ML ORAL SOLUTION (SO)", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 30, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.98, "maximum": 4.32, "gross_charge": 5.4, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "DIAZEPAM 5 MG/5 ML (1 MG/ML) ORAL SOLUTION (SO)", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 2.88, "maximum": 12.64, "gross_charge": 15.8, "payers_information": [{"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 12.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 11.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML ORAL SOLUTION (SO)", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.03, "maximum": 4.52, "gross_charge": 5.65, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.03, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MIDAZOLAM ORAL SYRUP ORDERABLE", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 4.58, "maximum": 20.12, "gross_charge": 25.15, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.89, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 14.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LEVETIRACETAM 100 MG/ML ORAL SOLUTION (SO)", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.35, "maximum": 5.92, "gross_charge": 7.4, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.92, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "LITHIUM CITRATE 60 MG/ML ORAL SOLUTION (SO)", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.01, "maximum": 4.44, "gross_charge": 5.55, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.14, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.01, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.3, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.22, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "MORPHINE 10 MG/5 ML ORAL SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.02, "maximum": 4.48, "gross_charge": 5.6, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.79, "maximum": 3.48, "gross_charge": 4.35, "payers_information": [{"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.1, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.02, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PHENOBARBITAL 20 MG/5 ML (4 MG/ML) ORAL ELIXIR", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 1.47, "maximum": 6.44, "gross_charge": 8.05, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.47, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.67, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PHENYTOIN 125 MG/5 ML ORAL SUSPENSION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 237, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 99.0, "maximum": 435.16, "gross_charge": 543.95, "payers_information": [{"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 112.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 99.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 387.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 315.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 435.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 387.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 127.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 315.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 473, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 42.88, "maximum": 188.48, "gross_charge": 235.6, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 167.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 48.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 42.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 136.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 55.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 188.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 167.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "POTASSIUM IODIDE 1 GRAM/ML ORAL SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "standard_charges": [{"setting": "outpatient", "minimum": 0.08, "maximum": 788.76, "gross_charge": 0.45, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.09, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "POTASSIUM IODIDE 1 GRAM/ML ORAL SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.08, "maximum": 788.76, "gross_charge": 1.4, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.33, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.81, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "POTASSIUM IODIDE 1 GRAM/ML ORAL SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 237, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.08, "maximum": 788.76, "gross_charge": 985.95, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 788.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 702.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 230.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 571.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 230.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 230.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 230.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 203.11, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 179.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 702.98, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 571.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "POTASSIUM IODIDE 1 GRAM/ML ORAL SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 30, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.08, "maximum": 788.76, "gross_charge": 864.25, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 691.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 616.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 202.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 501.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 202.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 202.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 202.23, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 178.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 157.29, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 616.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 501.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PROPRANOLOL 20 MG/5 ML (4 MG/ML) ORAL SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.06, "maximum": 102.0, "gross_charge": 0.35, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.06, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.25, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PROPRANOLOL 20 MG/5 ML (4 MG/ML) ORAL SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.06, "maximum": 102.0, "gross_charge": 3.4, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.7, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.97, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.8, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.42, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PROPRANOLOL 20 MG/5 ML (4 MG/ML) ORAL SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 15, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.06, "maximum": 102.0, "gross_charge": 5.1, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PROPRANOLOL 20 MG/5 ML (4 MG/ML) ORAL SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 2, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.06, "maximum": 102.0, "gross_charge": 0.85, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.18, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.49, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.68, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.61, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PROPRANOLOL 20 MG/5 ML (4 MG/ML) ORAL SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 20, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.06, "maximum": 102.0, "gross_charge": 6.8, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.94, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 5.44, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PROPRANOLOL 20 MG/5 ML (4 MG/ML) ORAL SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 5, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.06, "maximum": 102.0, "gross_charge": 1.7, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.35, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.31, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.99, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PROPRANOLOL 20 MG/5 ML (4 MG/ML) ORAL SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 500, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.06, "maximum": 102.0, "gross_charge": 127.5, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 26.27, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 23.21, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 73.95, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 29.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 102.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 90.91, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "PROPRANOLOL 20 MG/5 ML (4 MG/ML) ORAL SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 7, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.06, "maximum": 102.0, "gross_charge": 2.55, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.53, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.82, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 2.13, "maximum": 9.36, "gross_charge": 11.7, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.41, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.36, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.34, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.74, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 6.79, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TRIHEXYPHENIDYL 0.4 MG/ML ORAL ELIXIR", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 473, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 19.12, "maximum": 84.04, "gross_charge": 105.05, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 21.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 19.12, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 24.58, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 84.04, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 74.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 1, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 91.4, "maximum": 401.76, "gross_charge": 502.2, "discounted_cash": 301.32, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 291.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 117.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 117.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 117.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 91.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 358.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 401.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 358.07, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 117.51, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 291.28, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "ACYCLOVIR 200 MG/5 ML ORAL SUSPENSION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 473, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 38.48, "maximum": 169.16, "gross_charge": 211.45, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 122.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 169.16, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 150.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 122.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 150.76, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.56, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 49.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "AMINOCAPROIC ACID 250 MG/ML (25 %) ORAL SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 236, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 916.73, "maximum": 4029.6, "gross_charge": 5037.0, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4029.6, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3591.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1178.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2921.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2921.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1178.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1178.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1178.66, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1037.62, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 916.73, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3591.38, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CEFADROXIL 250 MG/5 ML ORAL SUSPENSION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 100, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 34.43, "maximum": 151.32, "gross_charge": 189.15, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 109.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 134.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 38.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 34.43, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 109.71, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 44.26, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 151.32, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 134.86, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 10, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.93, "maximum": 71.4, "gross_charge": 5.1, "payers_information": [{"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.05, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.93, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 4.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 3.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.19, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 100, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.93, "maximum": 71.4, "gross_charge": 44.65, "payers_information": [{"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 9.2, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 8.13, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 35.72, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 31.84, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 10.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.9, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 200, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.93, "maximum": 71.4, "gross_charge": 89.25, "payers_information": [{"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.39, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 16.24, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 71.4, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 63.64, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 20.88, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 51.77, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CHLORAL HYDRATE (BULK) CRYSTALS", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 125, "type": "GR"}, "standard_charges": [{"setting": "outpatient", "minimum": 13.65, "maximum": 60.0, "gross_charge": 75.0, "discounted_cash": 45.0, "payers_information": [{"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 60.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 43.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 53.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 15.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 13.65, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 17.55, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 15, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 0.46, "maximum": 2.0, "gross_charge": 2.5, "payers_information": [{"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.52, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.46, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 2.0, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.78, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 0.59, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 1.45, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "VALGANCICLOVIR 50 MG/ML ORAL SOLUTION", "code_information": [{"code": "2500003", "type": "CDM"}], "drug_information": {"unit": 88, "type": "ML"}, "standard_charges": [{"setting": "outpatient", "minimum": 103.5, "maximum": 454.96, "gross_charge": 568.7, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 329.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 405.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 117.15, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 103.5, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 133.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 133.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 133.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 329.85, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 133.08, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 454.96, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 405.48, "additional_payer_notes": "The gross charge reflected is based on average of possible supplier price methodologies. Not reimbursed separately.  Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HC Immune Adm 1 Vaccine", "code_information": [{"code": "90471", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "minimum": 70.86, "maximum": 2938.37, "gross_charge": 3456.9, "discounted_cash": 2074.14, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 70.86, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 70.86, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 70.86, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 70.86, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 70.86, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 60.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 60.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 70.86, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 60.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 49.4, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 51.7, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 54.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 54.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 70.86, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 70.86, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 70.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_dollar": 961.27, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 70.86, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 70.86, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 70.86, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 54.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_dollar": 961.27, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 70.86, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HC Immune Adm Vaccin Ea Add", "code_information": [{"code": "90472", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "minimum": 434.21, "maximum": 5801.04, "gross_charge": 6824.75, "discounted_cash": 4094.85, "payers_information": [{"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional services can be included in reimbursement.", "standard_charge_dollar": 434.21, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 71.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 54.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional services can be included in reimbursement.", "standard_charge_dollar": 434.21, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional services can be included in reimbursement.", "standard_charge_dollar": 434.21, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional services can be included in reimbursement.", "standard_charge_dollar": 434.21, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 71.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 70.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional services can be included in reimbursement.", "standard_charge_dollar": 434.21, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional services can be included in reimbursement.", "standard_charge_dollar": 434.21, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 54.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 54.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 51.7, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 49.4, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 60.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 434.21, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 60.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 60.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 434.21, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 434.21, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 434.21, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 434.21, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 434.21, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HC Immune Adm Vaccin Ea Add|UNUSUAL NON-OVERLAPPING SERVICE", "code_information": [{"code": "90472", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "minimum": 2858.84, "maximum": 18245.43, "gross_charge": 21465.2, "discounted_cash": 12879.12, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "case rate", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 2858.84, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "case rate", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 2858.84, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "case rate", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 2858.84, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "case rate", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 2858.84, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "case rate", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 2858.84, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 60.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 60.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "case rate", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 2858.84, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 60.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 49.4, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 51.7, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "case rate", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 2858.84, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "case rate", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 2858.84, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 70.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 71.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "case rate", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 2858.84, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "case rate", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 2858.84, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "case rate", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 2858.84, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 71.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "case rate", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 2858.84, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HC Ventilator Initial Day", "code_information": [{"code": "94002", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "minimum": 3190.73, "maximum": 58344.0, "gross_charge": 22585.98, "discounted_cash": 13551.59, "payers_information": [{"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "case rate", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3190.73, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "case rate", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 30508.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "case rate", "standard_charge_dollar": 25374.0, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "case rate", "standard_charge_dollar": 25785.0, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "case rate", "standard_charge_dollar": 25785.0, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "case rate", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3190.73, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "case rate", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 58344.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "case rate", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3190.73, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "case rate", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3190.73, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "case rate", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 30508.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 70.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "case rate", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 58344.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "case rate", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3190.73, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "case rate", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 58344.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "case rate", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3190.73, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "case rate", "standard_charge_dollar": 25374.0, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "case rate", "standard_charge_dollar": 25374.0, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "case rate", "standard_charge_dollar": 33041.0, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "case rate", "standard_charge_dollar": 22798.0, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "case rate", "standard_charge_dollar": 25785.0, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "case rate", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 39459.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "case rate", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 38129.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "case rate", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3190.73, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "case rate", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 39459.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "case rate", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 38129.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "case rate", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 39459.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "case rate", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 38129.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "case rate", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3190.73, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "case rate", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3190.73, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "case rate", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3190.73, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "case rate", "standard_charge_dollar": 25785.0, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "case rate", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 58344.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "case rate", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3190.73, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "case rate", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 3190.73, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "case rate", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 58344.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HC Ventilator Initial Day|UNUSUAL NON-OVERLAPPING SERVICE", "code_information": [{"code": "94002", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "minimum": 3523.85, "maximum": 37598.74, "gross_charge": 44233.75, "discounted_cash": 26540.25, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "case rate", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 3523.85, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "case rate", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 3523.85, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "case rate", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 3523.85, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "case rate", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 3523.85, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "case rate", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 3523.85, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 60.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 60.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "case rate", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 3523.85, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 60.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 51.7, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 49.4, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 54.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 54.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "case rate", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 3523.85, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "case rate", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 3523.85, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 70.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 71.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "case rate", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 3523.85, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "case rate", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 3523.85, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "case rate", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 3523.85, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 54.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, radiology services, supplies, and other services can be included in reimbursement.", "standard_charge_percentage": 71.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "case rate", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 3523.85, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HC Ventilator Sub Day", "code_information": [{"code": "94003", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "minimum": 608.03, "maximum": 24412.81, "gross_charge": 31396.93, "discounted_cash": 18838.16, "payers_information": [{"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_dollar": 608.03, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 71.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_dollar": 608.03, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_dollar": 608.03, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_dollar": 608.03, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 71.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 70.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_dollar": 608.03, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_dollar": 608.03, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 51.7, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 49.4, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 60.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_dollar": 608.03, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 60.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 60.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_dollar": 608.03, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_dollar": 608.03, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_dollar": 608.03, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_dollar": 608.03, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_dollar": 608.03, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HC Intra Pulm Surfact Admin", "code_information": [{"code": "94610", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "maximum": 8088.35, "gross_charge": 9515.7, "discounted_cash": 5709.42, "minimum": 85.65, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 85.65, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 85.65, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 85.65, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 85.65, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 85.65, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 60.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 60.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 85.65, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 60.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 49.4, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 54.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 51.7, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 54.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 85.65, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 85.65, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 70.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 71.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 85.65, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 85.65, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 85.65, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 54.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 71.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 85.65, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HC Aerosol Sameday Inhal Tx", "code_information": [{"code": "94640", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "minimum": 85.65, "maximum": 11421.15, "gross_charge": 11956.4, "discounted_cash": 7173.84, "payers_information": [{"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 85.65, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 71.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed 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"standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, 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service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 85.65, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 85.65, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 85.65, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 71.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 70.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 85.65, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 85.65, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 51.7, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 49.4, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 60.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 85.65, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 60.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 60.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 85.65, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 85.65, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 85.65, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 85.65, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 85.65, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, radiology services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HC Cont Aerosol Med 1st Hr", "code_information": [{"code": "94644", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "minimum": 327.77, "maximum": 15643.54, "gross_charge": 18994.15, "discounted_cash": 11396.49, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional radiology services can be included in reimbursement.", "standard_charge_dollar": 416.78, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional radiology services can be included in reimbursement.", "standard_charge_dollar": 416.78, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional radiology services can be included in reimbursement.", "standard_charge_dollar": 441.79, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional radiology services can be included in reimbursement.", "standard_charge_dollar": 441.79, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional radiology services can be included in reimbursement.", "standard_charge_dollar": 441.79, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 60.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 60.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional radiology services can be included in reimbursement.", "standard_charge_dollar": 441.79, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 60.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 49.4, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 51.7, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional radiology services can be included in reimbursement.", "standard_charge_dollar": 437.62, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional radiology services can be included in reimbursement.", "standard_charge_dollar": 429.28, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 70.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 71.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional radiology services can be included in reimbursement.", "standard_charge_dollar": 423.87, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional radiology services can be included in reimbursement.", "standard_charge_dollar": 423.87, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional radiology services can be included in reimbursement.", "standard_charge_dollar": 437.62, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional radiology services can be included in reimbursement.", "standard_charge_dollar": 416.78, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, and therapy services can be included in reimbursement.", "standard_charge_percentage": 71.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HC Cont Aerosol Med Ea Ad Hr", "code_information": [{"code": "94645", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "maximum": 14983.16, "gross_charge": 19369.25, "discounted_cash": 11621.55, "minimum": 215.52, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and therapy services can be included in reimbursement.", "standard_charge_percentage": 71.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 215.52, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 215.52, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 215.52, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 215.52, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and therapy services can be included in reimbursement.", "standard_charge_percentage": 71.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 70.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 215.52, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 215.52, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 51.7, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 49.4, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 60.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services can be included in reimbursement.", "standard_charge_percentage": 23.4, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 60.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 60.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services can be included in reimbursement.", "standard_charge_percentage": 23.4, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services can be included in reimbursement.", "standard_charge_percentage": 23.4, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services can be included in reimbursement.", "standard_charge_percentage": 23.4, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services can be included in reimbursement.", "standard_charge_percentage": 18.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services can be included in reimbursement.", "standard_charge_percentage": 20.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HC Nppv/Cpap Ventilation", "code_information": [{"code": "94660", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "minimum": 1527.08, "maximum": 18268.91, "gross_charge": 21993.8, "discounted_cash": 13196.28, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "case rate", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 6371.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "case rate", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1527.08, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "case rate", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1527.08, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "case rate", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 6371.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "case rate", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 4080.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "case rate", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1527.08, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "case rate", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1527.08, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "case rate", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 3274.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "case rate", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1527.08, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "case rate", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 3374.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "case rate", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 3374.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "case rate", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 3274.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "case rate", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1527.08, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "case rate", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 3374.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "case rate", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 3274.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "case rate", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 2591.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "case rate", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 4080.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "case rate", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 5793.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "case rate", "standard_charge_dollar": 4108.0, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "case rate", "standard_charge_dollar": 4108.0, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "case rate", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1527.08, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "case rate", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 6371.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "case rate", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1527.08, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "case rate", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 6371.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 70.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "case rate", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 4715.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "case rate", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1527.08, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "case rate", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1527.08, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "case rate", "standard_charge_algorithm": "Additional drugs and supplies can be included in reimbursement.", "standard_charge_dollar": 6371.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "case rate", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1527.08, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "case rate", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 4080.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "case rate", "standard_charge_algorithm": "Additional supplies can be included in reimbursement.", "standard_charge_dollar": 4080.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "case rate", "standard_charge_dollar": 4108.0, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "case rate", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1527.08, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "case rate", "standard_charge_algorithm": "Additional drugs can be included in reimbursement.", "standard_charge_dollar": 4715.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HC Nppv/Cpap Ventilation|UNUSUAL NON-OVERLAPPING SERVICE", "code_information": [{"code": "94660", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "maximum": 14852.22, "gross_charge": 18423.2, "discounted_cash": 11053.92, "minimum": 845.18, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 71.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 845.18, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 845.18, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 845.18, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 845.18, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 71.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 70.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 845.18, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 845.18, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 51.7, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 49.4, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 60.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 845.18, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 60.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 845.18, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 60.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 845.18, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 845.18, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 845.18, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 845.18, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HC Manip C Wall Intensv Int", "code_information": [{"code": "94667", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "minimum": 1751.79, "maximum": 15923.1, "gross_charge": 18733.05, "discounted_cash": 11239.83, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "case rate", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1751.79, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "case rate", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1751.79, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "case rate", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1751.79, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "case rate", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1751.79, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 60.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "case rate", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1751.79, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 60.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "case rate", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1751.79, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 60.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 49.4, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 51.7, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 54.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 54.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "case rate", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1751.79, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "case rate", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1751.79, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 70.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 71.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "case rate", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1751.79, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "case rate", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1751.79, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "case rate", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1751.79, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 54.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "case rate", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 1751.79, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional anesthesia services, drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 71.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HC Manip C Wall Intensv Int|DISTINCT PROCEDURAL SERVICE", "code_information": [{"code": "94667", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "minimum": 130.95, "maximum": 6291.2, "gross_charge": 7401.4, "discounted_cash": 4440.84, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 71.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional labs can be included in reimbursement.", "standard_charge_dollar": 130.95, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional labs can be included in reimbursement.", "standard_charge_dollar": 130.95, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional labs can be included in reimbursement.", "standard_charge_dollar": 130.95, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional labs can be included in reimbursement.", "standard_charge_dollar": 130.95, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 71.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 70.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional labs can be included in reimbursement.", "standard_charge_dollar": 130.95, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional labs can be included in reimbursement.", "standard_charge_dollar": 130.95, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 51.7, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 49.4, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 60.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional labs can be included in reimbursement.", "standard_charge_dollar": 130.95, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 60.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional labs can be included in reimbursement.", "standard_charge_dollar": 130.95, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 60.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional labs can be included in reimbursement.", "standard_charge_dollar": 130.95, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional labs can be included in reimbursement.", "standard_charge_dollar": 130.95, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional labs can be included in reimbursement.", "standard_charge_dollar": 130.95, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional labs can be included in reimbursement.", "standard_charge_dollar": 130.95, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HC Manip C Wall Intensv Int|UNUSUAL NON-OVERLAPPING SERVICE", "code_information": [{"code": "94667", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "maximum": 10622.22, "gross_charge": 12496.7, "discounted_cash": 7498.02, "minimum": 130.95, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 130.95, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 130.95, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 130.95, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 130.95, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 60.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 130.95, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 60.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 130.95, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 60.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 49.4, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 51.7, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 130.95, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 130.95, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 70.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 71.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 130.95, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 130.95, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 130.95, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 130.95, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 71.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HC Manip C Wall Intensv Sub", "code_information": [{"code": "94668", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "maximum": 14818.4, "gross_charge": 17433.4, "discounted_cash": 10460.04, "minimum": 171.3, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 71.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 171.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 171.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 171.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 171.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 71.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 70.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 171.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 171.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 51.7, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 49.4, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 60.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 171.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 60.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 171.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 60.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 171.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 171.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 171.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 171.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HC Manip C Wall Intensv Sub|DISTINCT PROCEDURAL SERVICE", "code_information": [{"code": "94668", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "minimum": 416.78, "maximum": 6291.2, "gross_charge": 7401.4, "discounted_cash": 4440.84, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional therapy services can be included in reimbursement.", "standard_charge_dollar": 416.78, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional therapy services can be included in reimbursement.", "standard_charge_dollar": 416.78, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional therapy services can be included in reimbursement.", "standard_charge_dollar": 441.79, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional therapy services can be included in reimbursement.", "standard_charge_dollar": 441.79, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional therapy services can be included in reimbursement.", "standard_charge_dollar": 441.79, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 60.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 60.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional therapy services can be included in reimbursement.", "standard_charge_dollar": 441.79, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 60.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 49.4, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 51.7, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional therapy services can be included in reimbursement.", "standard_charge_dollar": 437.62, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional therapy services can be included in reimbursement.", "standard_charge_dollar": 429.28, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 70.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 71.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional therapy services can be included in reimbursement.", "standard_charge_dollar": 423.87, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional therapy services can be included in reimbursement.", "standard_charge_dollar": 423.87, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional therapy services can be included in reimbursement.", "standard_charge_dollar": 437.62, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional therapy services can be included in reimbursement.", "standard_charge_dollar": 416.78, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 71.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HC Mechanical Chest Wall Oscill", "code_information": [{"code": "94669", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "minimum": 215.52, "maximum": 17226.99, "gross_charge": 20267.05, "discounted_cash": 12160.23, "payers_information": [{"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 71.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 215.52, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in 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file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total 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"standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 215.52, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 215.52, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 215.52, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 71.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 70.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 215.52, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 215.52, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 51.7, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 49.4, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 60.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services can be included in reimbursement.", "standard_charge_percentage": 23.4, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 60.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 60.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services can be included in reimbursement.", "standard_charge_percentage": 23.4, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services can be included in reimbursement.", "standard_charge_percentage": 23.4, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services can be included in reimbursement.", "standard_charge_percentage": 23.4, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services can be included in reimbursement.", "standard_charge_percentage": 18.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services can be included in reimbursement.", "standard_charge_percentage": 20.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, supplies, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HC Oximetry Overnight", "code_information": [{"code": "94762", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "minimum": 2507.93, "maximum": 11404.46, "gross_charge": 13780.0, "discounted_cash": 8268.0, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "case rate", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2507.93, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "case rate", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2507.93, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "case rate", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2507.93, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "case rate", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2507.93, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "case rate", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2507.93, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 60.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 60.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "case rate", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2507.93, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 60.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 51.7, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 49.4, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "case rate", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2507.93, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "case rate", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2507.93, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 70.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 71.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "case rate", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2507.93, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "case rate", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2507.93, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "case rate", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2507.93, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "case rate", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2507.93, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 71.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HC Transcutaneous Mnt Daily", "code_information": [{"code": "94799", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "minimum": 2507.93, "maximum": 11404.46, "gross_charge": 13780.0, "discounted_cash": 8268.0, "payers_information": [{"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "case rate", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2507.93, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 71.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "case rate", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2507.93, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "case rate", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2507.93, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "case rate", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2507.93, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 71.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 70.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "case rate", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2507.93, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "case rate", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2507.93, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 49.4, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 51.7, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 60.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "case rate", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2507.93, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 60.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 60.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "case rate", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2507.93, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "case rate", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2507.93, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "case rate", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2507.93, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "case rate", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2507.93, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "case rate", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2507.93, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HC Inj Intramuscular/Subcutaneous", "code_information": [{"code": "96372", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "minimum": 70.86, "maximum": 13733.44, "gross_charge": 13020.8, "discounted_cash": 7812.48, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 70.86, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 70.86, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 70.86, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 70.86, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 70.86, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 65.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 60.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 65.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 60.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 70.86, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 65.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 60.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 51.7, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 49.4, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 54.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 54.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 70.86, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 70.86, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 70.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 71.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 70.86, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 74.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 70.86, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 70.86, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 54.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 71.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 70.86, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HC Inj Intramuscular/Subcutaneous|UNUSUAL NON-OVERLAPPING SERVICE", "code_information": [{"code": "96372", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "minimum": 209.34, "maximum": 4508.5, "gross_charge": 6535.45, "discounted_cash": 3921.27, "payers_information": [{"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 209.34, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 71.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 54.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 209.34, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 209.34, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 74.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 209.34, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 71.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 70.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 209.34, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 209.34, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 54.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 54.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 49.4, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 51.7, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 60.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 65.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 209.34, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 60.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 65.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 60.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 65.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 209.34, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 209.34, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 209.34, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 209.34, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 209.34, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HC Flu Vaccine Admin", "code_information": [{"code": "G0008", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "minimum": 46.09, "maximum": 6041.05, "gross_charge": 5427.0, "discounted_cash": 3256.2, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs and radiology services can be included in reimbursement.", "standard_charge_dollar": 46.09, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs and radiology services can be included in reimbursement.", "standard_charge_dollar": 46.09, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs and radiology services can be included in reimbursement.", "standard_charge_dollar": 46.09, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs and radiology services can be included in reimbursement.", "standard_charge_dollar": 46.09, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 60.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 65.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs and radiology services can be included in reimbursement.", "standard_charge_dollar": 46.09, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 65.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 60.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 65.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs and radiology services can be included in reimbursement.", "standard_charge_dollar": 46.09, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 60.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 51.7, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 49.4, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 54.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 54.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs and radiology services can be included in reimbursement.", "standard_charge_dollar": 46.09, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs and radiology services can be included in reimbursement.", "standard_charge_dollar": 46.09, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 70.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 71.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 74.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs and radiology services can be included in reimbursement.", "standard_charge_dollar": 46.09, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs and radiology services can be included in reimbursement.", "standard_charge_dollar": 46.09, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs and radiology services can be included in reimbursement.", "standard_charge_dollar": 46.09, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 54.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and radiology services can be included in reimbursement.", "standard_charge_percentage": 71.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs and radiology services can be included in reimbursement.", "standard_charge_dollar": 46.09, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HC Flu Vaccine Admin|UNUSUAL NON-OVERLAPPING SERVICE", "code_information": [{"code": "G0008", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "minimum": 46.09, "maximum": 30069.26, "gross_charge": 36852.95, "discounted_cash": 22111.77, "payers_information": [{"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 46.09, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 71.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 46.09, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 46.09, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 46.09, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 71.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 70.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 46.09, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 46.09, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 54.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 51.7, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 60.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 46.09, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 60.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 46.09, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 60.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 46.09, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 46.09, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 46.09, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 46.09, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HC Pneumococcal Vac Admin", "code_information": [{"code": "G0009", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "minimum": 46.09, "maximum": 3608.34, "gross_charge": 3842.6, "discounted_cash": 2305.56, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 46.09, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 46.09, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 46.09, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 46.09, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 46.09, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 60.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 60.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 46.09, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 60.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 51.7, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 49.4, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 54.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 54.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 46.09, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 46.09, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 70.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_dollar": 1247.15, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 46.09, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 46.09, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 46.09, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 54.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_dollar": 1247.15, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs can be included in reimbursement.", "standard_charge_dollar": 46.09, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HC Pneumococcal Vac Admin|UNUSUAL NON-OVERLAPPING SERVICE", "code_information": [{"code": "G0009", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "minimum": 46.09, "maximum": 4956.27, "gross_charge": 5549.3, "discounted_cash": 3329.58, "payers_information": [{"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs and labs can be included in reimbursement.", "standard_charge_dollar": 46.09, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 71.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 54.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs and labs can be included in reimbursement.", "standard_charge_dollar": 46.09, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs and labs can be included in reimbursement.", "standard_charge_dollar": 46.09, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs and labs can be included in reimbursement.", "standard_charge_dollar": 46.09, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 71.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 70.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs and labs can be included in reimbursement.", "standard_charge_dollar": 46.09, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs and labs can be included in reimbursement.", "standard_charge_dollar": 46.09, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 54.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 54.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 49.4, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 51.7, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 60.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs and labs can be included in reimbursement.", "standard_charge_dollar": 46.09, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 60.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 60.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs and labs can be included in reimbursement.", "standard_charge_dollar": 46.09, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs and labs can be included in reimbursement.", "standard_charge_dollar": 46.09, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs and labs can be included in reimbursement.", "standard_charge_dollar": 46.09, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs and labs can be included in reimbursement.", "standard_charge_dollar": 46.09, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs and labs can be included in reimbursement.", "standard_charge_dollar": 46.09, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HC Hep B Vaccine Admin", "code_information": [{"code": "G0010", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "minimum": 46.09, "maximum": 10348.76, "gross_charge": 12174.95, "discounted_cash": 7304.97, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 46.09, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 46.09, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 46.09, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 46.09, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 46.09, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 60.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 60.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 46.09, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 60.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 51.7, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 54.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 46.09, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 46.09, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 70.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 71.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 46.09, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 46.09, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 46.09, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 71.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers. Additional drugs and other services can be included in reimbursement.", "standard_charge_dollar": 46.09, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HC Observation Room", "code_information": [{"code": "G0378", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "minimum": 130.95, "maximum": 8790.7, "gross_charge": 10342.0, "discounted_cash": 6205.2, "payers_information": [{"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 130.95, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services can be included in reimbursement.", "standard_charge_percentage": 71.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services and other services can be included in reimbursement.", "standard_charge_percentage": 54.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 130.95, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 130.95, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 130.95, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services and other services can be included in reimbursement.", "standard_charge_percentage": 74.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services can be included in reimbursement.", "standard_charge_percentage": 71.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services and other services can be included in reimbursement.", "standard_charge_percentage": 70.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 130.95, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 130.95, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services and other services can be included in reimbursement.", "standard_charge_percentage": 54.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services and other services can be included in reimbursement.", "standard_charge_percentage": 54.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services and other services can be included in reimbursement.", "standard_charge_percentage": 51.7, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services and other services can be included in reimbursement.", "standard_charge_percentage": 49.4, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services and other services can be included in reimbursement.", "standard_charge_percentage": 60.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services and other services can be included in reimbursement.", "standard_charge_percentage": 65.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 130.95, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services and other services can be included in reimbursement.", "standard_charge_percentage": 60.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services and other services can be included in reimbursement.", "standard_charge_percentage": 65.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 130.95, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services and other services can be included in reimbursement.", "standard_charge_percentage": 65.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services and other services can be included in reimbursement.", "standard_charge_percentage": 60.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 130.95, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 130.95, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 130.95, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 130.95, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional therapy services and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HC Observation Direct", "code_information": [{"code": "G0379", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "minimum": 416.78, "maximum": 8771.93, "gross_charge": 11426.9, "discounted_cash": 6856.14, "payers_information": [{"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional labs can be included in reimbursement.", "standard_charge_dollar": 416.78, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional labs can be included in reimbursement.", "standard_charge_dollar": 416.78, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional labs can be included in reimbursement.", "standard_charge_dollar": 441.79, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional labs can be included in reimbursement.", "standard_charge_dollar": 441.79, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional labs can be included in reimbursement.", "standard_charge_dollar": 441.79, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 60.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 60.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional labs can be included in reimbursement.", "standard_charge_dollar": 441.79, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 60.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 49.4, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 51.7, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 54.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 54.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional labs can be included in reimbursement.", "standard_charge_dollar": 437.62, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional labs can be included in reimbursement.", "standard_charge_dollar": 429.28, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 70.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 71.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional labs can be included in reimbursement.", "standard_charge_dollar": 423.87, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional labs can be included in reimbursement.", "standard_charge_dollar": 423.87, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional labs can be included in reimbursement.", "standard_charge_dollar": 437.62, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 54.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs and labs can be included in reimbursement.", "standard_charge_percentage": 71.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "fee schedule", "standard_charge_algorithm": "Additional labs can be included in reimbursement.", "standard_charge_dollar": 416.78, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HC Observation Direct|SIGNIFICANT, SEPARATELY IDENTIFIABLE EVALUATION AND MANAGEMENT SERVICE BY THE SAME PHYSICIAN ON THE SAME DAY OF THE PROCEDURE OR OTHER SERVICE", "code_information": [{"code": "G0379", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "minimum": 2507.93, "maximum": 12761.87, "gross_charge": 15013.95, "discounted_cash": 9008.37, "payers_information": [{"payer_name": "UNITED HEALTHCARE MEDICARE [251]", "plan_name": "BJC HB MEDICARE UHC SLC", "methodology": "case rate", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2507.93, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 71.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PRIORITY HEALTH [648]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNICARE [568]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "SARAH BUSH LINCOLN [636]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PREFERRED HEALTH PROFESSIONALS [561]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "PHCS [244]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN COMMERCIAL [737]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MULTIPLAN [240]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "NALC HEALTH BENEFIT PLAN [242]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MED-PAY [480]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MAIL HANDLERS [495]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [661]", "plan_name": "BJC HB WELLFIRST FIRST HEALTH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "MEDICA [662]", "plan_name": "BJC HB MEDICARE WELLFIRST SLC", "methodology": "case rate", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2507.93, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE ALT [672]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "case rate", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2507.93, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA MEDICARE [228]", "plan_name": "BJC HB MEDICARE HUMANA SLC", "methodology": "case rate", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2507.93, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HUMANA [203]", "plan_name": "BJC HB HUMANA CHOICECARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HFN [563]", "plan_name": "BJC HB HFN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 71.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE ORSCHELN BJH SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 80.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK SOI SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 48.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHCARE SOL MERCY [609]", "plan_name": "BJC HB ST JOHNS HEALTH SYSTEM", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHLINK [225]", "plan_name": "BJC HB HEALTHLINK HMO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH SYSTEMS INC [620]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTH ALLIANCE [224]", "plan_name": "BJC HB HEALTH ALLIANCE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 70.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FMH BENEFIT SERVICE INC [222]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "DETEGO HEALTH [868]", "plan_name": "BJC HB PHCS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "FIRST HEALTH COMMERCIAL [734]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ESSENCE HEALTHCARE [221]", "plan_name": "BJC HB MEDICARE ESSENCE SLC", "methodology": "case rate", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2507.93, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH NETWORK EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 69.5, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH [757]", "plan_name": "BJC HB MEDICARE COXHEALTH SLC", "methodology": "case rate", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2507.93, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "COX HEALTH SYSTEMS INSURANCE COMPANY [220]", "plan_name": "BJC HB COX HEALTH ACA", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE COE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CORESOURCE [497]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CONSOCIATE [478]", "plan_name": "BJC HB CONSOCIATE CARE D2E SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.2, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA SPECIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 51.7, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA LOCAL PLUS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 49.4, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "CIGNA [202]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 60.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD TRADITIONAL [500]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD MEDICARE [263]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "case rate", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2507.93, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB WASH U STUDENT HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 55.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 60.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM BLUE PREFERRED", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BLUE CROSS BLUE SHIELD [205]", "plan_name": "BJC HB ANTHEM ALLIANCE EPO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 85.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BEECHSTREET [551]", "plan_name": "BJC HB MULTIPLAN SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM TRADITIONAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 82.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM ACCESS SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 65.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS OOS [607]", "plan_name": "BJC HB ANTHEM CHOICE SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 60.9, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE ALT [649]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "case rate", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2507.93, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS IL [612]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "case rate", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2507.93, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "BCBS MEDICARE OOS [611]", "plan_name": "BJC HB MEDICARE ANTHEM ADVANTAGE SLC", "methodology": "case rate", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2507.93, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "APWU HEALTH PLAN [216]", "plan_name": "BJC HB CIGNA HMO/PPO SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 54.6, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 58.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE GOLD ADVANTAGE SLC", "methodology": "case rate", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2507.93, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA COMMERCIAL SLC", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 79.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB AETNA NATIONAL", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB FIRST HEALTH", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 74.3, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA [200]", "plan_name": "BJC HB GROUP HEALTH PLAN PPO SELECT", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Additional drugs, labs, radiology services, therapy services, and other services can be included in reimbursement.", "standard_charge_percentage": 75.0, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "AETNA MEDICARE [211]", "plan_name": "BJC HB MEDICARE ADVANTRA SLC", "methodology": "case rate", "standard_charge_algorithm": "Includes reimbursement for any outliers.", "standard_charge_dollar": 2507.93, "count": "0", "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HC Heliox Hourly", "code_information": [{"code": "270", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "minimum": 18.56, "maximum": 25.6, "gross_charge": 32.0, "discounted_cash": 19.2, "payers_information": [{"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 25.6, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.82, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 22.82, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.56, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 18.56, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]},
 {"description": "HC Nitric Oxide Gas Hourly", "code_information": [{"code": "270", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "minimum": 227.66, "maximum": 314.01, "gross_charge": 392.51, "discounted_cash": 235.51, "payers_information": [{"payer_name": "HOPE TRUST [806]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 227.66, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "ALLIED BENEFITS [498]", "plan_name": "BJC HB HOPE TRUST", "methodology": "percent of total billed charges", "standard_charge_dollar": 227.66, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "UNITED HEALTHCARE [201]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 279.86, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB HEALTHSCOPE EGYPTIAN TRUST SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 314.01, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}, {"payer_name": "HEALTHSCOPE BENEFITS [258]", "plan_name": "BJC HB UNITED HEALTH CARE SLC", "methodology": "percent of total billed charges", "standard_charge_dollar": 279.86, "additional_payer_notes": "Zero instances of the item or service in the 12 months prior to posting the file."}]}]}
 ]
}